Deductibles, Copayments, & Coinsurance

Below are brief descriptions of insurance terms associated with student’s share of covered expenses. Refer to the Certificate of Coverage for the Plan’s official definition. In addition to the explanations below, view StudentResources video to see how these insurance terms apply to a claim payment. The video uses a more basic plan designed compared to the Premier Plan’s, e.g., your in-network coinsurance is 10% rather than 20%, but it is still very helpful.

  • Deductibles: students must pay the Plan Year Deductible, first, before the Plan will begin to pay benefits, according to the applicable Provider Schedule. There is no Schedule 1 Deductible. Deductible amounts applied under Schedule 2/In-network and apply to Schedule 3/Out-of-Network.
  • Copayments: students must pay a small co-payment for each physician or mental health visit, at the time of the visit.
  • Coinsurance: students must share in the cost of their treatment as a percentage of the Allowable Amount.  The Allowable Amount includes deep discounts under Schedule 2.  Under Schedule 3, students are also responsible to pay the remainder of charges that are over and above the Allowable Amount. Refer to the Certificate for details about how the company determines the Allowable Amount.