Medical Common Insurance Terms Premium: The amount you pay for insurance Copayment (copay): The fixed amount you pay to receive services Deductible: The amount of money you are responsible for before insurance kicks in and starts paying their portion Coinsurance: The percentage of cost that is split between you and the insurance carrier once your deductible is met Out-of-Pocket Maximum: The most you will pay per plan year for health care expenses, including deductibles, flat dollar copays and coinsurance BlueLinks HMO $4,000 CommunityCare HMO $4,000 GlobalHealth HMO $4,000 Network BlueLinks HMO CommunityCare HMO GlobalHealth HMO Coinsurance 0% 0% 0% Office Visit Copay Primary: $25 Specialist: $50 Primary: $25 Specialist: $50 Primary: $0 Specialist: $50 Preventive Care Covered in Full Covered in Full Covered in Full Urgent Care Copay $50 Copay $50 Copay $25 Copay Emergency Room $300 Copay $300 Copay $400 Copay Outpatient Hospital Services $750 Copay per day $350 Copay per visit $300 / $800 Copay Preferred/Nonpreferred facility Inpatient Hospital Services $1,000 Copay per day to $3,000 Max $400 Copay per day to $2,000 Max $300 Copay per day to $900 Max Plan Year Deductible No Deductible No Deductible No Deductible Medical Out-Of-Pocket .Maximum Individual: $4,000 Family: $12,000 Individual: $4,000 Family: $10,000 Individual: $4,000 Family: $12,000 Prescription Coverage* Preferred / Non-Preferred Generic Brand Specialty $5 / $15 $40 / $80 $100 / $200 $0 / $15 $40 / $70 $300 $20 / $20 $65 / $90 $200 / $400 Amounts shown below are your responsibility.