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Who Pays For What?

Understanding terminology and who pays for what when using your health insurance can be confusing.

  • Premium – This is the flat amount you pay each month for your portion of the costs of your coverage. If you’re on an employer plan this comes out of your paycheck. If you have individual/family coverage this is typically an amount you pay to the insurance carrier yourself.

  • Deductible -  This is the total amount you pay for services before your plan begins to help with the costs. There are generally different deductible amounts for in-network vs out-of-network services. Premiums do not count towards your deductible.

  • Copayment – Also called co-pays, are fixed amounts you pay for certain services or items such as prescriptions, Dr office visits, etc. These can vary by the type of plan you have, or you may not have any copays. Co-pays also often do not count towards the deductible.

  • Coinsurance – This is the percentage of costs that you are responsible for, once you meet your deductible amount . Coinsurance will typically range from 20% - 50%.

  • Out-of-Pocket Max – This is the most you can pay for covered services in a 12-month calendar or plan year. Once you reach this amount your plan pays 100% of eligible healthcare expenses for the rest of the year.  

Have Questions?  We’re here to help!

BMA Financial Insurance Services is your trusted partner that can help bring clarity and understanding to whatever your situation may be. Let us help explain your options.

Our focus is on educating our churches and pastors to help them make well informed decisions about these very important topics.   


Mark Bradley

BMA Financial - Insurance Services


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