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Why is it important to no the difference between co-insurance and deductible?
Wiki User
∙ 13y ago
A deductible is the initial amount that the insured must pay out of pocket before the insurer's obligation to pay anything is triggered. It might be best understood as the amount for which you have agreed to self-insure before seeking assistance from the insurer. For example, if you have a $1000 collision deductible on your auto insurance, and a collision results in repair costs of $650, you would not have met your deductible, and the collision insurer would not have an obligation to pay.
In contrast, co-insurance is that percentage of a covered claim that you are obliged to pay. The context of health insurance probably provides the best example. A major medical policy may provide for a 20% copayment. This means that once any deductible is met, the insurer pays 80% of allowable charges, and the insured is responsible for the remaining 20%.
Wiki User
∙ 13y ago
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What is difference between health insurance deductible and out of pocket?
The deductible is how much you will pay before the plan starts helping you pay your medical bills. After you reach the deductible, most plans will pay a percentage of your bill and you pay the rest. This is called "co-insurance". Your out-of-pocketwill include the deductible and the coinsurance. Plans set a maximum out-of-pocket amount, after which the plan pays for all of your covered medical bills. The Affordable Care Act sets limits on deductibles and coinsurance, based upon your family income. You may qualify for help paying these in 2014.
What does eighty twenty coinsurance mean?
Eighty twenty coinsurance is usually expressed 80/20 by insurance companies. The first number (80) represents the percentage of payment an insurance company will pay for a service and the second number (20) is the percentage the person receiving the service is required to pay. Other popular coinsurance amounts are 70/30, 60/40, 50/50. It is important to note a couple of factors in determining when an insurance company will pay coinsurance. First, an insurance company will only pay 80% on what the insurance considers the "allowed" amount of a fee. Generally insurance companies have fee schedules which designate the maximum amount they will pay on any particular service. This allowed amount could be more or less than the fee that is charged for the service (usually the allowed amount is lower than the fee). Second, an insurance company will only pay 80% for services rendered after the insured has satisified their deductible. Therefore, if your insurance policy has a deductible of $500, the insured must pay out $500 towards their claims then insurance companies will consider paying 80% coinsurance on the remaining balance of unpaid services. Coinsurance does not apply to deductible amounts. Third, the service that is rendered must be a covered service under the insurance policy. If the service is not a covered service most insurance policies will not pay for the service, and usually it does not apply towards the deductible either. Lastly, if the provider of the service does not have a contract with your insurance company, the insured will most likely owe the difference between the allowed amount of the insurance company and the billed amount from the provider. Coinsurance does not apply to the portion of the fee that exceeds the insurance companies allowed amount. Billing the insured for this difference is referred to as balance billing.
What is the difference between Individual and family deductibles?
If an individual uses the entire amount for a family deductible is that okay
What is the difference between deductible and premium?
The premium is what you pay for the policy. The deductible is what the insurance company will not pay for what is covered. For example you buy a car policy for collision. You pay the premium of $50. If you crash the car, the company will not pay any thing less than the deductible. If the deductible was $1000 and you sustained $1500 damage, the company would pay you $500. If the damage was less than the deductible, you get nothing.
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Facultative reinsurance and coinsurance?
Facultative reinsurance is a form of reinsurance in which the terms, conditions, and reinsurance premium is individually negotiated between the insurer and the reinsurer. There is no obligation on the reinsurer to accept the risk or on the insurer to reinsure it if it is not considered necessary. The main differences between facultative reinsurance and coinsurance is that the policyholder has no indication that reinsurance has been arranged. In coinsurance, the coinsurers and the proportion of the risk they are covering are shown on the policy schedule. Also, coinsurance involves the splitting of the premium charged to the policyholder between the coinsurers, whereas the reinsurers charge entirely separate reinsurance premiums. Regards, Tamer Haddadin
What is the difference between Traditional versus Roth IRA?
The tax breaks for a "Traditional" IRA are tax-deductible where as the tax breaks in a "Roth" IRA are never tax-deductible. For more detailed information, speak to a financial adviser.
What is the difference between copay and coinsurance when you have primary and secondary insurance?
A copay is a "set" dollar amount you pay at the time of treatment. For instance, a $35 doctor copay. If you have level one doctor visits, you pay nothing more than the $35 doctor copay. Co-insurance is the percentage you share with the insurance company after your deductible has been met. When you have two policies - your primary insurance will pay first (subject to deductible and co-insurance), and then your second policy starts with the balance left from the primary policy (subject to deductible and co-insurance again). For instance a primary policy with a 5,000 deductible and 80/20 co-insurance of $5000. Your bill for surgery is 6000. You pay 5,000 + 20% of $5000 (1000) = $6000.00 Your balance of your surgery bill is 0
Difference between a deductible and a premium?
A premium is the amount of money you pay the auto/health insurance company monthly, quarterly, or biannually whether or not you get in an accident or go to the hospital. The higher your premium the lower your deductible, and the lower your premium the higher your deductible. A deductible is the amount of money after you get in a car accident or visit the hospital before your insurance company pays anything. After you have met your deductible the insurance company covers the rest of the expenses.
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You have an hmo insurance plan in Virginia your husband spends a lot of time in New York and is not covered by your hmo if you switch to a ppo will he be covered in N.Y. and if he is will it cost more?
Yes and Yes. An HMO provides coverage for in-network providers only and a PPO plan will cover both in and out-of-network providers. That is the main difference between the plans. However PPO rates are typically higher than HMO rates. Also if using an out-of-network provider, reimbursement is almost always based on a deductible/coinsurance arrangement with the plan typically paying either 70% or 80% of the bill after the deductible has been paid by you.
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