Dental Insurance

Complex procedures to normalize gums and teeth

A co-pay may disregard the deductible, co-insurance and out of pocket maximum. The co-pay is subject to specific services on your plan. For example, if your co-pay is $5 per generic brand prescription, each time you go to the pharmacy to obtain this or get a refill you will need to pay $5.

After a deductible is meet, co-insurance for each medical bill is implemented.

Example

Co-Insurance for doctor visits are 80%, which means you pay 20% of the bill. If the bill was $1,000, then you would pay $200. 

 A dollar amount required for the insured to pay before the insurance company will pay your medical bills. This dollar amount may be  per person/family on your plan.

Example

Your family deductible is $900 and your individual deductible is $1,000. You went to the doctor for an annual checkup costing $200 and the following week your son went to the ER for an injury with a bill of $1,300, then the insurance company will pay $500 (1,000 – 200 – 1,300) of your son’s bill along with paying co-insurance for each bill afterward.

The maximum amount an insured would pay after a deductible was meet.

Example

The deductible was $1,000, co-insurance is 80% and the out of pocket maximum is $1,500. You received an injury with a bill of $1,500, you would pay $1,100 (1,000 deductible + 20% co-insurance * 500 remaining bill after deductible was met). Your son was sick and admitted to the hospital a month later leaving a bill of $10,000, you would pay $1,400 ( 10,000 bill * 20% co-insurance – 100 from going over deductible previously). Any more medical bills after this will be covered completely covered.

The insurance company paid $400 ((1,500 bill – 1,000 deductible) * 80% co-insurance) for the first incident and $8,100 (10,000 bill * 80% co-insurance + 100 from the insured going over deductible previously) for the second.

The dollar amount that you pay consistently to the insurance carrier to own an insurance policy.