Deductibles, Coinsurance and Co-payments
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再過(guò)2個(gè)月就要enroll正式走上phd旅程了光羞，最近陸陸續(xù)續(xù)開(kāi)始做出發(fā)準(zhǔn)備，稍微查閱一些資料后對(duì)學(xué)校的醫(yī)保制度有所了解，摘錄一些網(wǎng)上的內(nèi)容并作如下總結(jié)昙啄。
在學(xué)校的statement中deductible,coinsurance和copayment這三個(gè)概念反復(fù)出現(xiàn)磷籍。而這三者的總和與out-of-pocket limit/maximum又有著直接聯(lián)系抠璃。這里先解釋一下out-of-pocket limit的概念。
Note:
Out-of-pocket expenses make up the cost-sharing part of your health insurance plan. These include things like deductibles, coinsurance and copayments that you contribute toward your annual health care costs, until you reach the maximum cost-sharing requirement -- your out-of-pocket maximum -- for the year. Once you reach the maximum, health insurance plans usually pay 100 percent for covered services and medical care for the remainder of the calendar year.
根據(jù)上文out-of-pocket limit實(shí)際上就是“每年個(gè)人所需支付的最高金額”蝠引，超過(guò)該金額的所有費(fèi)用均由保險(xiǎn)公司支付。顯然蛀柴，這個(gè)金額越低螃概，保費(fèi)肯定越貴（要不然保險(xiǎn)公司就太虧了）。每個(gè)保險(xiǎn)公司的out-of-pocket limit都不相同鸽疾，以我所在學(xué)校為例吊洼， 個(gè)人與家庭的指標(biāo)分別為$6,600和$13,200。
下面再來(lái)看deductible,coinsurance和copayment這三個(gè)概念制肮。
Note:
A deductible is the amount you pay before your health insurance benefits kick in and start paying. Until you meet the annual deductible, you’ll pay 100 percent of your medical bills. 解釋?zhuān)鹤愿冻^(guò)該金額冒窍，保險(xiǎn)公司才開(kāi)始賠付递沪。
Coinsurance starts after you meet the annual deductible and your insurance kicks in. In most policies, coinsurance is a percentage of the amount charged for a service. For example, in an 80/20 policy, your insurance will pay 80 percent and you’ll be responsible for the remaining 20 percent of the bill. 解釋?zhuān)簣?bào)銷(xiāo)比例，即保險(xiǎn)公司賠付與自付的比例综液。
A co-payment is a fixed dollar amount that you pay, usually at the time of service. Copays vary according to the type of service. For example, you might have a $5 copay for a prescription, a $20 copay for a doctor’s office visit and a $200 copay for emergency room treatment. Some plans do not include co-payments in the annual out-of-pocket maximum. 解釋?zhuān)横槍?duì)不同service所收取的固定費(fèi)用款慨，需自付。
Your health insurance plan may require both coinsurance and a co-payment for some services.
