Deductibles & Out-of-Pocket Expenses
The types of expenses are defined as follows:
- Copayment: a dollar amount that you are required to pay at the time services are rendered.
- Coinsurance: the percentage the member is responsible for when coverage is less than 100%.
- Deductible: an amount, usually stated in dollars, for which you are responsible each benefit period before the third party administrator will start to reimburse benefits.
Note: Retirees who have Medicare Part B as their primary health plan (age 65 and older) are not subject to the copayment when the RHP pays as secondary. However, for services not covered by Medicare and the service is a covered benefit by the RHP, the RHP then pays as primary. In this instance, you could be responsible for the applicable copayment.
