Back to Health plan 101

Understanding health care expenses

two women talking and looking at a piece of paper together

How health coverage payments work

Your health plan is a contract between you and us to pay for medical services. How much your plan pays and how much you pay will vary based on your coverage. Typical plan costs can include a monthly premium that you pay each month to access your health plan, as well as a system of cost-sharing that can consist of a copay, coinsurance, deductible or any combination of the three:

graphic of the cost-sharing system

  1. Deductible is the amount you pay before your health plan covers any costs
  2. Coinsurance is when you’ve met the deductible amount, and your health plan will start splitting the cost of additional medical care with you. You only pay a percentage or part of the total cost of services and your health plan will pay the rest.
  3. Copay is a fixed dollar amount for some care and prescriptions you pay each time you visit an office or refill that prescription. These all add to your maximum-out-of-pocket total or the dollar limit to your cost-sharing.

Cost of care

Knowing your care options before you need them saves you time and money. Learn more about the options for care, as well as associated costs.

Reading your explanation of benefits (EOB)

The EOB is not a bill. You’ll receive an EOB when using your health plan for covered care. The EOB lists the services used, the amount charged by the provider and your financial responsibility to pay toward deductibles or coinsurance. Learn more about how to read the explanation of benefits document.

Prior authorization

Some medical services require pre-approval by your health plan before receiving the service, commonly known as prior authorization. Our prior authorization process helps ensure you receive medically necessary care at the right time with the right provider. Learn more about the prior authorization process.

Preventive care

Preventive care is provided at visits that are usually with your primary care provider (PCP). Routine screenings, shots (vaccinations), and counseling to prevent illness, disease or other health problems are some examples of preventive care. These preventive care services are covered without any ($0) out-of-pocket costs to members when received by an in-network provider. Visit our preventive care page for more information on what is covered.

Billing