the amount you must pay for the healthcare services you or your family member receive. This is usually defined in a percentage amount. Often, co-insurance applies after first meeting a deductible requirement.

reinsurance agreement where the reinsuring company essentially accepts an agreed-upon percentage of the liability of a policy. In return, the reinsurer receives a proportionally equal share of the premium from that policy.

a portion of the medical expense that the individual must pay, with the insurance policy paying the rest; the co-insurance may be either in a dollar amount or as a percentage of the expense, such as 80 percent paid by the insurer and 20 percent (the co-insurance) paid by the insured.

The portion of the balance of covered medical expenses which a beneficiary must pay after payment of the deductible. Under Medicare Part B, the beneficiary pays coinsurance of 20 percent of allowed charges.

A cost-sharing requirement under a health insurance policy that provides that the insured will assume a portion or percentage of the costs of covered services. After the deductible is paid, this provision obligates the subscriber to pay a certain percentage of any remaining medical bills, usually 20 percent.

Co-insurance is the percentage of covered expenses paid by you each year after you have met applicable deductibles. Services that require deductibles and co-insurance are indicated in your benefits summary.

the portion of health care services for which the member is responsible. Co-insurance is usually structured on an 80 percent covered/20 percent non-covered basis.

The percentage of a charge for services that you may have to pay after you pay any plan deductibles. The coinsurance payment is a percentage of the cost of the service .

The percentage of a medical bill that is not covered by a patient's health policy and must therefore be covered out-of-pocket by the patient.

A cost-sharing arrangement under which a covered person pays a specified percentage of the cost of a specified service, such as 20% of the cost of a doctor's office visits.

If the insured is required to pay any portion of the covered expenses, this is known as co-insurance.

The insured's share of covered health insurance benefits, usually a percentage.

The amount of money a health plan will pay for covered expenses, usually expressed in a percentage.

The arrangement whereby the insured pays a specific portion of covered expenses with the plan paying the balance.

the amount paid by the patient each time a covered drug is purchased, when the drug cost is more than the deductible. The co-insurance may be different for one drug than for another. There can be one value for a generic drug, one for a preferred drug, and one for a non-preferred drug. The co-insurance may also vary throughout the year, from 0 to 100 percent.

The percentage paid by the Member for each eligible benefits expense.

Percentage due from the patient after insurance has processed and issued payment on a claim.

A requirement under a health plan where the member is responsible for a portion or percentage of the cost of covered services.

The percentage you pay for eligible expenses after you satisfy the deductible, if any. There is usually a maximum amount of Co-Insurance that is incurred each year before the plan kicks in at 100% for the rest of the year. Co-Insurance applies to Indemnity plans, Out-of-Network Point-of-Service (POS), and Preferred Provider Organization (PPO) plans.

An agreement between the insured and the insurance company where payment is shared for all claims covered by the policy. A typical arrangement is 80%/20% up to $5,000. The insurance company pays 80% of the first $5,000 and the insured pays 20%. Usually after 80% of $5,000, the insurance company then pays 100% of covered expenses during the remainder of the calendar year up to any limits of the policy.

The portion of incurred, covered healthcare costs, expressed in terms of a percentage of covered charges, for which the insured is financially responsible. Co-insurance usually applies after the insured meets his or her deductible requirements.

The amount you pay after your health plan has paid its share. A typical coinsurance amount is 10% or 20% of the amount the plan allows for the services you received. Most PPOs require the consumer to pay a percentage of the cost of their care.

The portion of covered health care costs for which the covered person has a financial responsibility, usually a fixed percentage. Coinsurance usually applies after the insured meets his/her deductible. Consolidated Omnibus Budget Reconciliation Act (COBRA) - a federal law that, among other things, requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance has been terminated if they undergo a triggering event.

Most policies require the insured to pay some portion of the health care bills. A typical arrangement is that the insurer pay 80% and the insured 20%, up to $5,000 out-of-pocket. After hitting the maximum out of pocket limit, the insurance company pays 100% of covered expenses during the remainder of the calendar year, up to any maximum limits of the policy.

In a health insurance policy, after you pay the deductible, the insurance company pays a percentage and you pay a percentage; 80/20 - insurance pays 80 percent and you pay 20 percent.

Requirement of an insurance policy or prepayment plan that a percentage of the provider's charges be paid by the covered employee/dependant. Comprehensive health care delivery system - Health care facilities and professionals organized and coordinated to provide comprehensive health care to a defined population group. Concurrent review - Review of the medical necessity of hospital or other health facility admissions upon or within a short period following an admission and the periodic review of services provide during the course of treatment. The initial review assigns an appropriate length of stay to the admission (using diagnosis specific criteria) which may also be reassessed periodically. Where concurrent review is required, payment for unneeded hospitalizations or services is usually denied.

The amount you are required to pay for medical care after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent. Coordination of Benefits: A system to eliminate duplication of benefits when you are covered under more than one group plan. Benefits under the two plans usually are limited to no more than 100 percent of the claim.

the part of the medical expenses the insured must pay if hospitalized in the U.S.A. or Canada.

This is the percentage or amount of expenses that the insured pays (if any) after the deductible is satisfied. For example: Co-Insurance = 20% (80/20) means that the insurance company pays 80% of the charges, and the insured pays 20%. Usually there is a stop-loss or maximum out-of-pocket for the insured. 80/20 to $5,000 means that the insured will pay 20% of the next $5,000 of expenses (after the deductible) which equates to another $1,000 potentially out-of-pocket for the insured.

A feature in a benefit plan that apportions expenses between health plan participants and an insurer or plan sponsor in a specified ratio (such as 80 percent paid by the insurer and 20 percent by the participant).

A kind of cost sharing where costs are split on a percentage basis. For example, a plan might pay 75 percent and you would pay 25 percent. See cost sharing.

The co-insurance clause requires you to pay a percentage (or a fixed dollar amount) of your covered medical expenses. The percentage is usually expressed as "80/20" co-insurance. This means after you have paid the deductible amount (if any) as stated in your policy, you will pay 20% of the medical bills and the insurance company will pay the remaining 80% of the covered medical expenses. When your total expenses reach a dollar amount stated in your policy, the insurance company pays 100% of the covered expenses up to the maximum benefit of your policy (from $2000 to $50,000.)

Splitting costs on a percentage basis. After you reach the set deductible amount in your Medicare Prescription Drug Plan, you will share costs with the plan and pay a predetermined co-insurance percentage.

A fixed percentage of the amount allowed to the provider for which the insured is responsible, after meeting their deductible.

A cost-sharing requirement where the insured person pays a portion of the costs of covered services. For example, under the standard Part D benefit, in 2006 beneficiaries will pay co-insurance equal to 25% of their total drug costs between $250 and $2,250.

A type of cost -sharing arrangement where Medicare beneficiaries pay a percentage of the approved amount for a covered health service.

The percentage of a medical bill that a patient must pay that is not covered by a health policy.

Arrangement by which the health plan and the member share, in a specific ratio, payment for losses covered by the plan after the deductible is met (for example, 80/20, meaning the plan pays 80% and the member pays 20%.)

Participation of several insurers in one risk with each insurer assuming a certain amount of the sum insured.

A fixed percentage amount, such as 10 percent, paid by the enrollee time a certain covered service is received. In most cases, if deductible applies, the remaining charge is subject to coinsurance.

A predetermined percentage of the Eligible Charges for covered Services that a participant must pay directly to the provider for certain Health Care Services after the Deductible has been met within the Calendar year.

The arrangement by which the patient and the insurance company share the covered losses under a policy. For example, the insurance company may reimburse the patient for 80% of covered expenses, with the patient paying the remaining 20% of such expenses. Coordination of Benefits (COB): A method of integrating benefits payable under more than one group health insurance plan so that the insured's benefits from all sources do not exceed 100% of the allowable medical expense.

the portion of the service provided not reimbursed under your employer's health insurance coverage

Cost-sharing arrangement in which the patient is required to pay a percentage of the cost for the health care services received (e.g., 20% of the cost of ENBREL).

to guard, protect, safeguard, or shield, co-insurance designates the set amount of money that an insured individual is asked to pay for health care services, after the insurance company has met the deductible. Usually a group health insurance policy also outlines co-insurance or "co-payment." Co-insurance is normally listed as a percentage. For example, an employee pays 10 percent of total fees for any healthcare service and the employer or designated health insurance provider covers the remaining balance.

Money that the insured is required to pay for services, usually a certain percentage, after the deductible is met.

the percentage of covered expenses an insured individual shares with the carrier. (i.e., for an 80/20 plan, the health plan member's co-insurance is 20%.) If applicable, co-insurance applies after the insured pays the deductible and is only required up to the plan's stop loss amount. (see "stop loss.")

The percent of each health care bill you must pay out of your own pocket. Non-covered charges and deductibles are in addition to this amount.

This is a type of cost sharing where the insured party and insurer share payment of the approved charge for covered services in a specified ratio after payment of the deductible. Most fee-for-service plans require a 20 percent co-insurance for covered inpatient and outpatient medical/surgical services.

Amount of co-insurance applied (patient out-of-pocket expense) to allowable charges.

It refers to a group of insurers that cover a risk together.

the amount that has to be paid after the deductible for Medicare Part A and/or Part B is paid. The coinsurance payment is a percentage of the approved amount for the service (like 20%). Passport Health Plan usually pays this for you because you are enrolled in Medicaid.

When a group of insurers cover a risk together.

The percentage of the total value of the incurred expenses for which the Policyholder/Insured Person is responsible.

in property insurance, when the insurance policy contains this clause, co-insurance defines the amount of each loss that the company pays. The co-insurance requirement may be 50, 80, 90 or 100%. The formula for claims payment is as follows: Amount of Insurance Carried Amount of Insurance Required (The Percentage Required) Amount of loss= Insurance Company Payment

Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some health care plans, co-insurance is called "co-payment." Co-insurance is often specified by a percentage. For example, the employer or insurance company pays 80 percent and the employee pays 20 percent toward the charges for a service rendered.

The portion of covered health care costs the covered person is financially responsible for, usually according to a fixed percentage. Coinsurance often is applied, according to a fixed percentage, after a deductible requirement is met.

A provision in a member's coverage that limits the amount of coverage by the plan to a certain percentage, usually 70% or 80%. Additional costs are paid by the member. The percentage paid by the member is referred to as coinsurance and is typically 30% or 20% of the charges.

A share of healthcare premiums that is paid by the insured.

Refers to money that a patient is required to pay for services (usually after a deductible has been paid).

A sharing of insurance risk between the insurer and the insured. Coinsurance depends on the relationship between the amount of the policy and a specified percentage of the actual value of the property insured at the time of the loss.

A policy provision frequently found in major medical insurance policies under which the insured individual and the insurer share hospital and medical expenses according to a specified ratio.

"The portion of covered health care expenses that must be met by the policyholder, in addition to the deductible. This figure is usually expressed as a percentage. For example, in a traditional 80/20 plan, the insurer pays 80 percent of the doctor's bill and the patient pays 20 percent. This is based on the insurance company's definition of what constitutes a physician's ""reasonable and customary"" fee. NOTE: Many physicians' charges are higher than the ""reasonable and customary"" fee and the patient is responsible for 100 percent of the excess amount. This is known as ""balance billing."""

A percentage for the total approved amount on an insurance claim.

A traditional method of paying for covered health services in which portions of the covered expenses are shared by the health plan and the member. Co-insurance is a defined percentage of the covered charges for services rendered. For example, under a contract the health plan may pay 80 percent of the fee maximum for a particular covered service rendered by a preferred physician and the member will pay 20 percent of the fee maximum. Or, under a contract the health plan may pay 70 percent of the fee maximum for a particular covered service rendered by a non-preferred physician and the member will pay 30 percent and may be required to pay the difference between the health plan fee maximum and the non-preferred physician's requested payment amount.

Where two or more parties share the same insured risk. A reinsurer is not a co-insurer with the original insurer.

The amount of health care bills you are required to pay after you have met the deductible. The co-insurance rate is usually expressed as a percentage, i.e., the insurance company pays 80 percent and you pay 20 percent, up to a maximum out-of-pocket limit. After you hit the maximum out-of-pocket limit, your insurance company pays 100% of covered expenses during the remainder of the calendar year, up to any maximum limits of the policy.

In many British-type insurance markets, co-insurance means the sharing of one insurance policy between two or more insurers. Usually, this entails each insurer paying directly to the insured their respective share of the loss. In other words, the insured has an insurance contract with more than one insurer. This arrangement is cumbersome to administer and is used only on very large risks.

Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some health care plans, co-insurance is called "co-payment." Co-insurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent.

Arrangement by which the insurer and the insured share, in a specific ratio, payment for losses covered by the policy, after the deductible is met.

the fixed amount or percentage you pay after paying the deductible. For example, if your insurance plan pays 80 percent of your medical expenses after you meet a $250 annual deductible, you are responsible for the remaining 20 percent.

A means of spreading the risk on larger insurances between two or more direct insurers.

An arrangement by which a number of insurance companies cover a particular risk.

A provision of a medical expense insurance policy that requires the insured to pay a percentage of all eligible medical expenses, in excess of the deductible, that result from sickness or injury. eductible: The amount a policyholder must pay before insurance covers any expenses. The insurance program pays benefits only for losses over the amount stated in the deductible provision.

The part (usually a percentage) of the covered health care cost for which you are financially responsible. Often, co-insurance applies after you meet your deductible.

after the Deductible amount is satisfied, Members are responsible for payment of a portion of UCR (Usual, Customary and Reasonable) for Covered Non-Emergency Services. Such Co-insurance charges will count toward the Co-insurance Maximum for covered services.

A percentage the patient is responsible for on a given insurance claim

Coinsurance, like co-payments, is a common form of member cost-sharing. It is typically applied as a percentage of applicable costs after the deductible requirements are met. With traditional non-managed care plans, the percentage is based on provider charges, sometimes up to a maximum allowable amount per service. In managed care plans, the percentage can be based upon provider contract rates.

Many insurers require that homeowners insure their homes for at least 80 percent of REPLACEMENT COST. If the homeowner fails to do this, a penalty is applied to partial losses. This penalty is usually referred to as Co-insurance.

The portion of the bill for a medical service that must be paid by the patient (Co-insurance refers to a percentage; co-payments are stated as flat amounts).

means you pay part. Where you would most commonly see co-insurance would be with medical or dental benefits.

Co-insurance is when you have to pay for a percentage of your care. For example, your insurance may pay 80% of a charge. The remaining 20% is your co-insurance. In other words, if the total bill is $100, your co-insurance would be $20.

Coverage that involves the use of two or more insurers..

Your share of medical expenses normally after you have paid your deductible.

A fixed percentage of all remaining expenses a patient must pay after the deductible has been met.

The amount you must pay for medical care in a point-of service plan (POS) or preferred provider organization (PPO) after you have reached your deductible. It is often a percentage of bills charged.

Where two or more parties share the same risk. A co-insurer is not obliged to follow the decision of another co-insurer, except where they have given authority for the other party to act on their behalf. Each co-insurance is a separate contract with the insured.

An arrangement whereby a number of separate insurance companies share in the cover of one particular risk.

The percentage of the charge for drugs that a Part D enrollee may have to pay after any plan deductibles are paid. For instance, 10% co-insurance on a $50 prescription would be $5.

After paying the deductible, percentage or amount of covered expenses that the insured pays. For example, an insurance policy brochure may mention that the policy will pay 80% of the first $5,000 and 100% thereafter of the usual and customary charges; In some health insurance plans, it is also called "co-payment". e.g., Suppose you buy insurance policy with $50,000 policy maximum, $250 deductible per policy period and 80/20 co-insurance for the first $5000 and 100% coverage thereafter. Suppose you incur covered expense of $10,250. You pay first $250 deductible; then out of the remaining $10,000 covered expenses, you pay 20% of the first $5000 (i.e., $1000); the insurance policy pays for the remaining expenses (i.e. $9,000). That means, you pay $250 + $1000 = $1250 total; and insurance company pays $4000 + $5000 = $9000.

A term that describes a shared payment between an insurance company and an insured individual. It's usually described in percentages; for example, the insurance company agrees to pay 80% of covered charges and the individual picks up 20%.

In health insurance, the percentage of the claims that an individual must pay, less the deductible. In property and casualty insurance, a provision that requires the insured to maintain a specified amount of insurance based on the value of the property insured.

Policy condition requiring the sum insured to be maintained for a specified minimum percentage of the actual cash value. If not maintained, the insured must bear a proportionate amount of any partial loss.

A form of cost-sharing in a health-insurance policy that requires a group member to pay a percentage (often 10-30 percent) of all eligible medical expenses after the deductible amount has been paid and before the out-of-pocket maximum has been reached. For example, the insurance carrier typically picks up 70-90 percent of the cost, and the member pays the difference.

Where a number of different insurers subscribe to a single insurance policy.

the division of a risk between two or more insurers where each is individually liable to the insured for their proportion of claims.

A form of cost-sharing in which the member and the plan each pay a set percentage for covered services.

Insurance issued by two or more insurers.

Coverage involving the use of two or more insurers. see coinsurance.

(1) In property insurance, a clause under which the Insured shares in losses to the extent that he is underinsured at the time of loss; (2) Where two or more Insurers each have part of the risk under a single insurance policy.

After a deductible has been fulfilled, the co-insurance is the portion of a medical expense that you must contribute. It’s usually expressed as a percentage, i.e. a 30% co-insurance means that after you meet your deductible, you pay 30% and the insurance company pays 70% of your medical expenses. This is usually subject to the insurers Reasonable & Customary fees.

The sharing of an insurance policy by two or more insurers. This arrangement is for large risk where the various insurers are indicated with their respective participating share in the policy.

A form of insurance whereby more than one insurer carries the risk and where each is individually and proportionally liable to the insured for settlement of a claim.

A requirement that a property carry a minimum coverage (usually 80% of replacement cost) in order to collect 100% of the loss. If a person carries only a percentage of the amount required, then that person only gets that percentage of the loss suffered.

Sharing of the risks between several insurers. A given risk is covered by several Companies within a single contract, with each Company covering a share (expressed in %), on the basis of which it receives its share of the total premium and, in a similar proportion, contributes to the indemnification in the event of a claim.