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 Amounts shown below are your responsibility . CommunityCare HMO $4,000 GlobalHealth HMO $4,000 Network CommunityCare HMO GlobalHealth HMO Coinsurance 0% 0% Office Visit Copay Primary: $25 Specialist: $50 Primary: $25 Specialist: $50 Preventive Care Covered in Full Covered in Full Urgent Care Copay $50 Copay $25 Copay Emergency Room $300 Copay $400 Copay Outpatient Hospital Services $350 Copay per visit $300 / $800 Copay Preferred/Nonpreferred facility Inpatient Hospital Services $400 Copay per day to $2,000 Max $400 Copay per day to $2,000 Max Plan Year Deductible No Deductible No Deductible Medical Out - Of - Pocket . Maximum Individual: $4,000 Family: $10,000 Individual: $4,000 Family: $12,000 Prescription Coverage* Preferred / Non - Preferred Generic Brand Specialty $0 / $15 $40 / $70 $300 $20 / $20 $65 / $90 $200 / $400