Co-Insurance

Co-insurance is the percentage of costs you pay after you have met your deductible.

For example, a patient may have a 20% co-insurance for a physician office visit if the provider is in the plan that the patient belongs to, or patient may have a 40% co-insurance for a physician office visit if the provider is not in the plan that the patient belongs to. The provider may calculate an estimated amount to collect from the patient or may wait until after the claim has been processed to collect the actual amount from the patient (requirements may vary from plan to plan). If the patient's portion of responsibility for a benefit is nothing, "0" is to be placed in benefitPercent.