What does the term coinsurance mean?
Coinsurance means members split their eligible healthcare costs with the insurance carrier. For example, if your health plan has an 80/20 in-network (out-of-network coinsurance levels will differ from the in-network coinsurance levels) coinsurance rate for specific services (e.g., OEBB medical plans 3 through 9), this means after the deductible has been satisfied, the insurance company is then responsible for 80 percent of the eligible charges and the member is responsible for the balance. Once a member reaches their plan year out-of-pocket maximum, the insurance carrier will pay for 100 percent of the eligible expenses (subject to plan limitations).
