Cost-sharing
Copay
A fixed dollar amount you pay for a covered service at the time of care — for example, $30 for an office visit or $15 for a generic prescription. Copays are typically not subject to the deductible.Last reviewed: · TMRW Benefits is a benefits brokerage, not a tax or legal advisor. Consult a CPA or attorney for situation-specific guidance.
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Premium
Monthly payment to keep coverage active.
Deductible
Out-of-pocket amount you pay before insurance starts paying.
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.
Balance billing
Out-of-network provider bills you the gap.
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