Coinsurance - A form of medical cost sharing in a health insurance plan that requires an
insured person to pay a stated percentage of medical expenses after the deductible
amount, if any, was paid.
♦ Once any deductible amount and coinsurance are paid, the insurer is responsible
for the rest of the reimbursement for covered benefits up to allowed charges: the
individual could also be responsible for any charges in excess of what the insurer
determines to be “usual, customary and reasonable”.
♦ Coinsurance rates may differ if services are received from an approved provider
(i.e., a provider with whom the insurer has a contract or an agreement specifying
payment levels and other contract requirements) or if received by providers not
on the approved list.
♦ In addition to overall coinsurance rates, rates may also differ for different types
of services.
