Glossary (Part 1)
Coinsurance
The share of your covered expenses, usually a percentage, you must pay after the deductible is reached. For example, a policy may require you to pay twenty percent of the cost up to a certain dollar amount.
Conversion of Privileges
Allows the participant or beneficiaries to convert coverage to a different plan of insurance without providing evidence of insurability. The privilege granted by a group policy is to convert to an individual policy upon termination of group coverage.
Coordination of Benefits
Provisions in group policies that limit the total benefits payable under two or more group policies so that benefits do not exceed the actual amount of covered expenses incurred. COB is particularly important when a husband and wife each have obtained family coverage under separate group policies. Some policies may reduce the amount of benefits payable if benefits are payable under other insurance coverage.
Co-Payment
A specified dollar amount a subscriber to a managed care plan must pay for covered health care services. It is paid to the provider at the time the service is rendered.
Deductible
The initial amount of covered expenses a policyholder will have to pay before benefits are paid under the policy. Generally, the higher the deductible, the lower your premium. Remember, the deductible should not be so high that you could not afford to pay it should you become ill. Ask your agent or company representative if the deductible is a flat annual amount or if you must pay a deductible for each treatment, or for each family member. Some major medical policies have what is known as a “variable deductible” which means that the deductible will be the greater of a fixed dollar amount or the dollar amount or the total expense coverage.
Source: ins.state.pa.us
