KEY TERMS Annual Deductible Out-of-Pocket Copays/Coinsurance Maximum The amount you have to pay each year The total amount you can pay These expenses are your share of the before the plan starts paying a portion out of pocket each year before cost paid for covered health care of the medical expenses. the plan pays 100 percent of services. Embedded (E) –Each covered family covered expenses for the rest of Copays–A fixed dollar amount, usually member only needs to satisfy their the year. due at the time you receive care. individual deductible, not the entire Most expenses that meet Coinsurance – A percentage share of family deductible prior to receiving provider network requirements the allowed amount charged for the plan benefits. count toward the annual out-of- service. It is generally billed to you after Non-Embedded (A) –The entire family pocket maximum, including the health insurance company has deductible must be satisfied before expenses paid to the annual reconciled the bill with the provider. copays/coinsurance is applied to any deductible, copays and family member. coinsurance. 10