Understanding Your Health Insurance Benefits

What is a Copayment  (Copays)? 

Copays are a fixed amount you pay for a covered health care service, usually when you receive the service.

For example, if you have an office visit with your primary care physician (PCP), your copay may be a fixed amount such as $30. If you have a copay, this is usually the only fee you will have to pay when you visit your doctor (other services such as lab tests or x-rays may result in additional fees). Choosing a plan with a copay for services you receive often may help you minimize your out-of-pocket expenses.

What is Deductible?

A deductible is the amount you owe for health care services before Unity begins to pay. For example, if your deductible is $1,000, Unity won’t pay anything until you’ve met your $1,000 for covered health care services subject to the deductible. The deductible may not apply to all services.

What is Coinsurance?

Coinsurance is your share of the costs of a covered health care service, calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe.

For example, if your plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20 percent would be $20. Unity pays the rest of the allowed amount.

What is Usual, Customary and Reasonable Charge (UCR)?

UCR is the amount Unity will pay for a medical service. This is based on what other providers in the area usually charge for the same kind of service. You may be responsible for paying charges that are above the UCR and other out-of-pocket costs.

What is the Maximum Out-of-Pocket Limit (MOOP)?

MOOP is the most you will pay in cost sharing in a plan year for covered services.  This does not include your monthly premium.

Interested in learning more?  Read Life of a Claim

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