The information in this section covers basic facts about how health insurance plans work but is not intended to provide specific details about individual benefit programs.

For answers that will be specific to your own individual health coverage, please contact your Human Resource Department, your Plan Administrator, the member service line of your Insurance Plan, or the broker responsible for your Insurance Plan.

In addition, you may want to click on to the Health Insurance Glossary for definitions of common health insurance terms.

• How much will my insurance pay for services? How much will I have to pay if I have a co-pay (co-payment)? What is a co-pay (co-payment), anyway? How much will I have to pay if I have co-insurance? What is co-insurance? What do my employer and I each pay with co-insurance? (100%, 80%-20%, or what?)

• Do I have a deductible? What is a deductible? What is my deductible amount?

• I had this same insurance at Company X, but my co-pay was a different amount and my payroll deduction was different? Why is that?

• Is this procedure covered by insurance, and how do I find this out?

How much will my insurance pay for services? How much will I have to pay if I have a co-pay (co-payment)? What is a co-pay (co-payment), anyway? How much will I have to pay if I have co-insurance? What is co-insurance? What do my employer and I each pay with co-insurance? (100%, 80%-20%, or what?)

Benefits, co-insurance, and payments for healthcare services are all determined by your employer's benefit plan. Co-payments and payroll deductions are also determined by your employer's benefit plan. Employers determine how much they will contribute to their employee's benefits and how much their employees will contribute.

If you are responsible to pay for a portion of the cost of your medical treatment, it may be in the form of a co-pay or co-insurance. Your coinsurance or co-payment may be listed on your Member Identification Card. Remember that co-insurance is not the same as a copayment.

A co-payment (copay) is a specified dollar amount that a patient must pay for covered health care services at the time the service is rendered.

Co-insurance is the share of covered expenses, usually a percentage, that a person must pay after a deductible is reached. For example, a policy may require people to pay twenty percent of the cost of a procedure up to a certain dollar amount

Do I have a deductible? What is a deductible? What is my deductible amount?

You may have a deductible if you have a certain type of medical insurance policy. A deductible means you have to pay a certain amount for covered medical expenses before your insurer will pay anything for your medical expenses. It is important to remember that these expenses must be covered medical expenses so check your member handbook to determine what is covered and what is not covered to get the best value for your medical dollar..

The amount you pay for your deductible depends on your employer's plan because employers determine how much they will contribute to their employee's benefits and how much their employees will contribute.

If you are a covered person under the current policy, you can verify your coverage by reading your about your plan benefits in your Member Handbook. You can also contact your employer or the Member Services Department of your plan for further information.

I had this same insurance at Company X, but my co-pay was a different amount and my payroll deduction was different? Why is that?

Co-payment and payroll deduction are determined by your employer's benefit plan design. Employers determine how much they will contribute to their employee's benefits, and how much their employees will contribute. So, even if you had this insurance with another employer, your current employer probably has a different plan with the insurance company, giving you different financial obligations.

Remember that a co-payment (Co-pay) is not the same thing as co-insurance:

A Copayment (copay) is a specified dollar amount that a patient must pay for covered health care services at the time the service is rendered.

Co-insurance is the share of covered expenses, usually a percentage, that a person must pay after a deductible is reached. For example, a policy may require people to pay twenty percent of the cost of a procedure up to a certain dollar amount.

Is this procedure covered by insurance, and how do I find this out?

If you are a covered person under the current policy, you can verify your coverage by reading your plan benefits in your Member Handbook. You can also contact your employer or the Member Services Department of your plan for further information.