Texas Family Benefits specializes in individual, Medicare, and group health insurance in Houston as well as throughout the state of Texas.

Health Insurance Terms | Co-insurance & Stop-loss

By admin on July 28, 2010 | Listed under Health Insurance Glossary | Leave a comment |

This posting is a continuation of the series on Health Insurance Terms.

In a Health Insurance policy, once you have met your deductible, if you do not have a 100 percent plan then you are in the part of the policy of Co-insurance. That is where the insured and the insurance co share in the costs. Then when you have spent your full Co-insurance amount then the insured is 100 percent covered for the remaining period of time in the plan year.

Co-insurance – 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.

Stop-loss – the dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

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