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Premium:

(AKA monthly premium) This is another term for "Bill." You pay your health insurance premium in order to receive the coverage & benefits offered by the insurance company.

Deductible:

The amount chosen by the insured to be met before certain benefits are to be paid by insurer. Note: The lower the deductible/ the higher the monthly premium.

Co-Insurance:

Co-Insurance is the amount to be paid by the policy holder and insurance company after the deductible has been met. The most common coinsurance is 80/20%. But, many plans now offer a variety of coinsurance options for premium containment such as 50/50%, 70/30%, or even 100%! Example: Many plans have a common "80/20" structure. This simply means that after you have satisfied the deductible, you and the insurance company would split the remaining cost of treatment 80/20 (you paying 20% of the remaining bill & the insurance company paying 80%) until you have reached your "STOP LOSS" or "Maximum Out Of Pocket."

STOP LOSS or "Maximum Out Of Pocket":

See above. This is the maximum amount of your annual exposure. Usually, your deductible and coinsurance total. Example: Let’s say you have a $1000 deductible plan. This plan is an "80/20" co-insurance plan. This means that your Co-Insurance Max is $2,000. This simple example tells us that you have paid your deductible of $1000. Then, you paid your co-insurance of 20% until your "Maximum Out-Of-Pocket" of $3,000. After this maximum out-of-pocket ($3,000), the carrier has to cover all remaining expenses 100%. *See diagram below.

Broken Leg Injury Statement
Total medical expense:	$10,000
Your deductible:	-$1,000

Remaining	$9,000
You now split this amount 80/20
until your “stop loss” of	-$2000

Your “Maximum Out-Of-Pocket”	-$3000*
Insurance company pays	$7000

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