留学生Insurance常用语解释

Deductibles, Coinsurance and Co-payments

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再过2个月就要enroll正式走上phd旅程了，最近陆陆续续开始做出发准备，稍微查阅一些资料后对学校的医保制度有所了解，摘录一些网上的内容并作如下总结。

在学校的statement中deductible,coinsurance和copayment这三个概念反复出现。而这三者的总和与out-of-pocket limit/maximum又有着直接联系。这里先解释一下out-of-pocket limit的概念。

Note:
Out-of-pocket expenses make up the cost-sharing part of your health insurance plan. These include things like deductibles, coinsurance and copayments that you contribute toward your annual health care costs, until you reach the maximum cost-sharing requirement -- your out-of-pocket maximum -- for the year. Once you reach the maximum, health insurance plans usually pay 100 percent for covered services and medical care for the remainder of the calendar year.

根据上文out-of-pocket limit实际上就是“每年个人所需支付的最高金额”，超过该金额的所有费用均由保险公司支付。显然，这个金额越低，保费肯定越贵（要不然保险公司就太亏了）。每个保险公司的out-of-pocket limit都不相同，以我所在学校为例， 个人与家庭的指标分别为$6,600和$13,200。

下面再来看deductible,coinsurance和copayment这三个概念。

Note:
A deductible is the amount you pay before your health insurance benefits kick in and start paying. Until you meet the annual deductible, you’ll pay 100 percent of your medical bills. 解释：自付超过该金额，保险公司才开始赔付。
Coinsurance starts after you meet the annual deductible and your insurance kicks in. In most policies, coinsurance is a percentage of the amount charged for a service. For example, in an 80/20 policy, your insurance will pay 80 percent and you’ll be responsible for the remaining 20 percent of the bill. 解释：报销比例，即保险公司赔付与自付的比例。
A co-payment is a fixed dollar amount that you pay, usually at the time of service. Copays vary according to the type of service. For example, you might have a $5 copay for a prescription, a $20 copay for a doctor’s office visit and a $200 copay for emergency room treatment. Some plans do not include co-payments in the annual out-of-pocket maximum. 解释：针对不同service所收取的固定费用，需自付。
Your health insurance plan may require both coinsurance and a co-payment for some services.