医保词汇:Copay,Deductible, Coinsurance的差别!!!

2024-11-23 12:53:15
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回答1:

定义:
Co-payment: Co-payment or as it is called 'Co-pay' is the set amount that the insurance company requires you to pay for services such as doctor visits, prescriptions or emergency room visits.
Deductible: This is the set amount that you select and agree to pay out-of-pocket before the insurance company starts to pay any part of certain medical charges.
Coinsurance: This is the amount that the health insurance companies require you to pay as your portion of the medical charges. For example, with the 80/20 coinsurance requirement, after you have satisfied the deductible, if the hospital bill is $1000, then you are responsible for 20% ($200) and the insurance companies pays the balance 80% or $800.
三者的关系
Coinsurance is sometimes used synonymously with copayment, but is defined differently – a copay is typically fixed while the coinsurance is a percentage that the insured pays after the insurance policy's deductible is exceeded up to the policy's stop loss. It is expressed as a pair of percentages with the insurer's portion stated first. The maximum percentage the insured will be responsible for is generally no more than 50%. Once the insured's out-of-pocket expenses equal the stop loss the insurer will assume responsibility for 100% of any additional costs. 70-30, 80-20, and 90-10 insurer-insured coinsurance schemes are common, with stop loss limits of $1,000 to $3,000 after which the insurer covers all expenses.