Verify Your Insurance

Your deductible is the amount you must pay before your insurance begins to pay for your covered healthcare service costs for any given year. For example, if you have a $2,000 deductible, you pay for the first $2,000 of service costs yourself. Once your deductible is met, you are only responsible for applicable copayment and coinsurance costs. Your insurance covers the rest.

Your copayment is the fixed amount you pay for a covered healthcare service, like a doctor’s office visit. Copayments can occur before or after a deductible is met, depending on your insurance plan. The health insurance verification system does not show your copayment information.

Your coinsurance fee is the percentage of the healthcare service cost that you’re financially responsible for. Coinsurances kick in once your deductible is met. For example, if you’ve paid your deductible, the allowed amount for a doctor’s visit on your plan is $100, and your coinsurance is 20%, you will pay 20% of $100, or $20.

Your out-of-pocket maximum is the maximum amount you must pay for covered healthcare services for any given year. Once you meet your out-of-pocket maximum, your insurance plan pays for 100% of additional covered healthcare services costs.

Your policy effective date is when your insurance company begins paying for your covered healthcare costs. You must enroll in a health insurance plan during the open enrollment period, which is typically held once per year or during a special enrollment period. Special enrollment periods last about 90 days and can begin after a qualifying event, like marriage, new employment, childbirth, or the loss of healthcare coverage. Your policy effective date is determined after enrollment and is usually a few weeks or months after your initial enrollment date.