Cost-sharing
Balance billing
When an out-of-network provider bills you for the difference between their charge and what the insurer allowed. Limited by federal No Surprises Act protections for emergency care, air ambulance, and most in-network-facility services performed by out-of-network providers.Last reviewed: · TMRW Benefits is a benefits brokerage, not a tax or legal advisor. Consult a CPA or attorney for situation-specific guidance.
More in Cost-sharing
Premium
Monthly payment to keep coverage active.
Deductible
Out-of-pocket amount you pay before insurance starts paying.
Copay
Flat fee per service. Often not subject to the deductible.
Coinsurance
Percentage of cost you pay after deductible.
Out-of-pocket maximum (OOP max)
Annual cap on your covered in-network costs.
Allowed amount
Maximum the plan considers reasonable for a service.
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