Coinsurance is the percentage of medical services that you have to pay for. A higher coinsurance (80%) means that you need only to pay for 20% of medical services, whereas a lower coinsurance (60%) means that you need to pay for 40% of medical services. This coinsurance applies for in-network providers in the US or expenses outside the US.

An out-of-pocket maximum is the most you will have to pay under your health insurance plan.

This is the maximum amount of coverage you can receive from your policy over the policy period. An unlimited maximum benefit is a sign of a more comprehensive policy, as this means there are no limits on the amount of coverage you can receive on your plan.

Prescription drug prices are typically presented as either as a percentage (i.e. 20%), meaning you pay 20% of the drug price, or are broken down based on tiers ($10 for tier 1, $20 for tier 2, 40% for tier 3). Because drug prices can vary widely, it is always, always better to choose a plan that has fixed drug prices regardless of the “tier” the drug is in. Tier 1 drugs are mostly generic drugs, tier 2 drugs are a mix of brand-name and generic drugs, and tier 3 drugs are mostly brand-name drugs.

This is what you pay to see a doctor. (outside of university campus)

This is the amount you have to pay when receiving treatment at the student health center in your university. Our plans have a $0 co-pay at the university, which means that office visits at your university will be free.

This is the cost you have to pay when you go to the emergency room. Usually, if you need immediate treatment, you go to an emergency. For instance, if you get food poisoning and need immediate attention, you will visit an emergency room.

Outpatient services refer to the medical services that you receive without an overnight stay. This is the commonest type of treatment. Inpatient services refers to treatment that you receive with a stay at the hospital.

Inpatient mental health services cover both overnight or longer stay in a hospital for a patient with psychiatric concerns or drug intoxication, and outpatient mental health services refers to psychiatrist and psychologist office visits.

Without insurance, the median cost is $1233 for an emergency room visit, and the average cost for staying overnight in the hospital is $4923. The charge for an ambulance ranges from $700 to $1290, with additional charges of $12 per mile traveled. Thus, insurance coverage of these services is critical.

Preventive care services include annual physicals, routine screenings, and vaccinations. This is important for your overall, routine maintenance of health.

A reimbursement-based plan means that you will have to pay for the full cost of medical services up front, and later receive reimbursement from the insurance provider. Many doctors and medical centers do not accept reimbursement based plans. Further, many students cannot afford such a heavy charge and thus it is critical to ensure that your health insurance policy is not reimbursement-based. This is why several universities do not allow reimbursement based plans.

Any injury sustained while engaging in physical recreation or sporting events comes under this. If this was not covered, and you are playing soccer with your friends, fall and get hurt, you would have to pay the entire cost of going to the emergency room, seeing a doctor, getting an X-ray, getting surgery and a cast, and getting pain medications.

A waiting period for pre-existing conditions means that before the insurance company covers any cost related to your condition, you must be on the policy for “X” amount of time, typically 6 months. If you do not have any pre-existing conditions, then limitations or exclusions on pre-existing conditions do not affect your insurance coverage.