A co-payment is the amount you pay when you go to the doctor.
All Savers plans have different co-payments based on the type of service or provider of service. For example, a regular visit would have a lower co-payment than a visit to the emergency room.
A medical credit is an amount of money that you can use to help pay for many of your everyday health care costs before the deductible.
With All Savers Standard plans, you don’t need to do anything for a medical credit—it’s built in. You and your enrolled spouse each get a medical credit, which any enrolled family member can use. Unusued amounts don’t “roll over” to the next year. But whether you use it all or not, you’ll start each year with a full medical credit.
A wellness credit is an amount of money that you can use to help pay for many of your everyday health care costs before the deductible.
All Savers Wellness plans give you (and your enrolled spouse) the chance to earn a wellness credit by meeting a few simple health targets in a health screening. Your children can’t earn one, but the wellness credits that you and your spouse earn can be used by any of your enrolled family members. Unused amounts don’t “roll over” to the next year, but each year you meet the health targets you’ll earn a new wellness credit.
If you are unable to meet the health screening targets, you might qualify for an opportunity to earn the wellness credit by a different means. Contact us at 800-291-2634 and we will work with you (and, if necessary, with your doctor) to find another way for you to earn the wellness credit.
A deductible is the amount you owe for health care services your plan covers before your plan begins to pay. For example, if your deductible is $2,000, your plan won’t pay anything until you’ve met your $2,000 deductible for covered health services.
Some All Savers plans include medical or wellness credits that offer some coverage before the deductible.
Health care costs only count toward the deductible if they are covered by the plan. Also, co-payments don’t count toward the deductible.
If you get health care from outside the network, it will count toward a separate, out-of-network deductible. Deductibles reset each calendar year. Family deductibles are two times the individual amount.
Out-of-Pocket Limit is the most you pay during a plan year before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium or health care your health plan doesn’t cover.
Co-payments, co-insurance and deductible payments count toward your out-of-pocket limit. Out-of-network payments count toward a separate, non-network out-of-pocket limit. Out-of-pocket limits reset each year.
Pharmacy co-payments are your share of the cost of prescription drugs. Prescription drugs are grouped into four tiers. Each drug tier has a different co-payment, based on the cost.
Mail-order prescription (90-day supply) co-payments are 2.5 times the retail pharmacy co-payment.* To see a list of the prescription drugs included in each tier, visit the Find a Doctor page and view the Find a Pharmacy section.
*For fully insured plans, mail-order co-payments in Alabama and Mississippi are 3 times the retail pharmacy co-payments.
After you meet your deductible, a percentage of your health care costs are covered through co-insurance.
For example, if your plan has 80/20 co-insurance, once you meet your deductible, the plan will pay 80 percent of eligible costs, and you’ll pay the other 20 percent (plus the co-payments).
Health care costs can only be paid through co-insurance if they are covered by the plan. If you get health care from outside the network, it might have a lower “non-network” co-insurance rate.
The coinsurance limit is the maximum amount of coinsurance you would pay in a year (if you have very high medical costs). If you ever reach this limit, all other eligible medical costs are covered 100 percent, minus your copayments.
The amount you choose is for an individual, for in-network services. Family coinsurance limits vary by state. Non-network coinsurance limits accumulate separately. Coinsurance limits reset each calendar year. Copayments do not count toward coinsurance limits.
A co-payment is the amount you pay when you go to the doctor.
All Savers plans have different co-payments based on the type of service or provider of service. For example, a regular visit would have a lower co-payment than a visit to the emergency room.
A medical credit is an amount of money that you can use to help pay for many of your everyday health care costs before the deductible.
With All Savers Standard plans, you don’t need to do anything for a medical credit—it’s built in. You and your enrolled spouse each get a medical credit, which any enrolled family member can use. Unusued amounts don’t “roll over” to the next year. But whether you use it all or not, you’ll start each year with a full medical credit.
A deductible is the amount you owe for health care services your plan covers before your plan begins to pay. For example, if your deductible is $2,000, your plan won’t pay anything until you’ve met your $2,000 deductible for covered health services.
Some All Savers plans include medical or wellness credits that offer some coverage before the deductible.
Health care costs only count toward the deductible if they are covered by the plan. Also, co-payments don’t count toward the deductible.
If you get health care from outside the network, it will count toward a separate, out-of-network deductible. Deductibles reset each calendar year. Family deductibles are two times the individual amount.
The coinsurance limit is the maximum amount of coinsurance you would pay in a year (if you have very high medical costs). If you ever reach this limit, all other eligible medical costs are covered 100 percent, minus your copayments.
The amount you choose is for an individual, for in-network services. Family coinsurance limits vary by state. Non-network coinsurance limits accumulate separately. Coinsurance limits reset each calendar year. Copayments do not count toward coinsurance limits.
Pharmacy co-payments are your share of the cost of prescription drugs. Prescription drugs are grouped into four tiers. Each drug tier has a different co-payment, based on the cost.
Mail-order prescription (90-day supply) co-payments are 2.5 times the retail pharmacy co-payment.* To see a list of the prescription drugs included in each tier, visit the Find a Doctor page and view the Find a Pharmacy section.
*For fully insured plans, mail-order co-payments in Alabama and Mississippi are 3 times the retail pharmacy co-payments.
After you meet your deductible, a percentage of your health care costs are covered through co-insurance.
For example, if your plan has 80/20 co-insurance, once you meet your deductible, the plan will pay 80 percent of eligible costs, and you’ll pay the other 20 percent (plus the co-payments).
Health care costs can only be paid through co-insurance if they are covered by the plan. If you get health care from outside the network, it might have a lower “non-network” co-insurance rate.
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