General Topics

What is a deductible?

An annual deductible is the dollar amount that you, the insured, must pay each year before the insurance company pays anything.

What is coinsurance or a co-pay?

Coinsurance or co-payment is the amount beyond the deductible that the insured pays.

What is annual out-of-pocket maximum?

An annual out-of-pocket maximum cost is the most you could pay in a given calendar year.

What is the annual stop-loss?

The annual stop-loss is the sum of the annual deductible and the maximum annual co-payment / coinsurance.

What is the lifetime maximum payment?

The lifetime maximum payment sets a dollar limit on what the insurance company must pay for any one individual’s medical costs over a lifetime (often $1,000,000).

What are exclusions and pre-existing conditions?

Exclusions and pre-existing conditions exclude certain illnesses or deny payment on claims that relate to a condition or illness that existed before the coverage began.

What is coordination of benefits?

Coordination of benefits means that the companies will coordinate benefits payments with one another if you are covered by more that one insurer. This helps avoid double paying to hospitals and doctors.