When choosing a benefit plan, consider all costs that will be your responsibility as a member. The Benefit Summaries for your plan will list all applicable costs.
Coinsurance is the proportion of cost that the member is responsible for paying for a medical service. For example, the NHPTwo plan requires the member to pay 50% of the cost of a brand name drug, while NHP covers the other 50%.
A copayment is a set amount a member has to pay at the time of receiving a service. For example, the NHPOne plan requires members to pay a $10 copayment at the time of a medical office visit.
A deductible is an amount that a member has to pay out-of-pocket before the health plan begins to pay for certain services. A plan's Benefit Summary will specify which services are subject to a deductible. The deductibles for NHP Commonwealth Choice plans apply on a per-calendar-year basis.
An out-of-pocket maximum is the total maximum amount that a member can pay per calendar year for a particular medical service or services. Once the out-of-pocket maximum is reached, the health plan will begin covering that service or services in full.
A premium is a monthly cost that is paid by the member. As a member, you are required to pay your monthly premium whether or not you receive healthcare services during that month.
