Your healthcare expenses will fall into 2 categories. Premiums and Out-of-Pocket Expenses.
- A Premium is the price you pay to be enrolled in an insurance plan. For SSHIP this is collected through tuition and fees bills, while for Grad Plan it is collected through a payroll deduction.
- Out-of-Pocket Expenses are what you pay to receive individual services. These include Co-insurance, Co-payments, and Deductibles.
Co-insurance is the percentage of the cost that you must pay. For SSHIP your co-insurance is generally 20% for Network Providers. This means for each dollar that the treatment costs you pay 20 cents and the insurance pays 80 cents.
Co-payments are a set fee that you pay for certain services. For example, in SSHIP you have a $10 co-payment for generic prescription drugs and a $35 co-payment for a doctor's appointment.
A Deductible is the minimum amount of money you must spend on healthcare before insurance will pay its share of the co-insurance. For some services the deductible may be waived, meaning that you do not have to pay the deductible before insurance will begin paying co-insurance. In SSHIP and Grad Plan doctor office visits waive the deductible after the co-payment. This means in most cases you will pay only $35 for the visit. The Out-of-Pocket Maximum is the maximum amount of money you will have to pay for health care under most circumstances.