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Health Insurance Glossary

Definitions for common health insurance terms

coinsurance

DEFINITION:

Coinsurance refers to money that an individual is required to pay for services, after a deductible has been paid. Coinsurance is often specified by a percentage. For example, the insured pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent.  After the insured has paid the deductible, he’s responsible for a percentage of the costs, specified by the coinsurance split (80/20, 90/10, and 70/30 are common coinsurance splits, with the insured paying the smaller percentage and the carrier paying the higher percentage).  That remains the case until the out-of-pocket maximum (OOMP) for the year is reached.  At that point, the insurance company starts to pay 100 percent of covered claims until the end of the year.

Related terms: copayment, deductible