What is the difference between co-payment and coinsurance?
A co-payment is a flat dollar amount payable by you to the provider at time of service. Covered medical services that are listed with a co-payment amount are not included in the calendar year deductible. You will always make a co-payment for service, regardless of whether or not you have met your calendar year deductible amount. Coinsurance is a percentage of the cost of medical care. Covered medical services that are listed with a coinsurance percentage are included in the calendar year deductible and, after the deductible is met, payable at the applicable coinsurance amount. You are responsible for the deductible amount and the remaining percentage for the covered service. You may also be responsible for the portion of an out-of-network charge that exceeds the usual and customary (U&C) allowance. What applies to the out-of-pocket maximum? The deductibles, co-payments (except prescription drug co-pays and human organ and tissue transplants), and the participant’s portion of the coinsu
