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 Non-Embedded (A) – The entire family pocket maximum, including after 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. 9