Your portion of the costs are paid in three ways. Your payroll contribution, annual deductible, and coinsurance or copayment. Your out-of-pocket maximum limits the amount you will pay each year.
Each pay, you share the cost of your plan through a payroll deduction. This amount was on your enrollment worksheet when you enrolled for your benefits. These contributions are paid on a pre-tax basis which reduces your taxable income, resulting in less tax being taken from your pay.
When you use medical care during the year, you pay for all of your medical services until you reach your annual deductible. After you've reached this amount, the Plan begins to share the cost of your medical care through coinsurance.
However, not all services require you to meet a deductible. Take a look at your medical chart to see which ones require you to meet a deductible.
Coinsurance or Copayment
After you've incurred enough medical services to reach your annual deductible, you and the Plan share the cost of your medical expenses through coinsurance or copayment, which is a percentage of the cost. The Plan pays the majority of the cost.
Annual Out-of-Pocket Maximum
You will continue to contribute to your coinsurance amount until your annual out-of-pocket maximum is reached. Once reached, the Plan pays 100% of your eligible medical costs for the remainder of the year. Some people think of their annual out-of-pocket maximum as the “worst-case scenario.”
Your out-of-pocket maximum includes the money you've spent toward reaching your annual deductible plus your share of coinsurance costs. Each plan has different out-of-pocket maximums, and the maximums are tracked on an individual basis and a family basis.