An insurance plan or policy that requires partial payment for health and medical services by the policyholder.
A cost-sharing requirement under a health insurance policy which provides that the insured, will assume a portion or percentage of the costs of covered services. The health insurance policy provides that the insurer will reimburse a specified percentage (usually 80 percent) of all, or certain specified covered medical expenses in excess of any deductible amounts payable by the insured. The insured is then liable for the remaining percentage of the costs, until the maximum amount payable under the insurance policy, if any, is reached.
A percentage to be paid by a health care plan enrollee (beneficiary) of the cost of health care services. For example, the enrollee have a 50% coinsurance contract, which requires the enrollee to pay 50% of the charge amount which has been approved for that service by the plan. The health plan pays its portion of the charge (50% in this case) and sends the enrollee an Explanation of Benefits which shows the amount owed by the enrollee. The enrollee sends payment directly to the provider of the service. This is a method of cost-sharing between the enrollee and the plan, and serves as an incentive for the enrollee to stay healthy and to use health care resources wisely, thus helping to contain health care costs.
Also called a copayment; the percentage of health care costs that people must pay themselves after paying their deductible (the dollar amount that is paid for health care each year before health plans begin to pay). For example, if a person owes a 20 percent coinsurance payment and makes an office visit that costs $100, he or she is responsible for a copayment of $20 for that visit.
A common form of private medical insurance policy in which the patient or other beneficiary of the policy shares the costs of treatment for injury or disease with the insurance company. A typical co. insurance policy might stipulate that the insurance company would pay 80% of the patient’s claim for medical expenses with the patient paying the remaining 20%.