Deductible
Each year, you pay 100% of your covered expenses until you meet your deductible amount. For most plans, eligible preventive care is covered at 100% with no deductible when you use network providers.
Cost Sharing
Coinsurance: A fixed percentage. For example, if your care is $100 and your coinsurance is 20%, you pay $20.
Copay: A fixed dollar amount. For example, you may pay $30 per doctor office visit.
Out-of-pocket maximum
The maximum you pay each year for covered expenses. Once you hit your maximum, the plan pays 100% of covered expenses for the rest of the year. Copays/deductibles may accumulate towards meeting the maximum out of pocket expenses for your plan.
Injury
Injury means bodily damages:
- caused directly and independently of all other causes by an accident; and,
- which results in loss covered by the Plan
Sickness
Sickness means illness or disease for which treatment is received while the person is covered under this Plan.
Disability
Disability means either a sickness or injury
Plan Year
A plan year means the fiscal year as described under period of coverage above.