Family coinsurance maximum

Our pre-health-reform plans refer to this as an out-of-pocket maximum that applies to your coinsurance. In general, it's the most your family will pay in coinsurance during a plan year.

• Coinsurance is when you pay a percentage of the cost of a medical service or prescription and your plan pays the rest. Usually, you pay coinsurance for a stay in the hospital, for example.
• Once the coinsurance paid by everyone on your plan combined reaches the family coinsurance maximum, your plan begins to pay 100% for covered services. See your plan documents for exceptions.

Some plans have two different coinsurance maximums

• Coinsurance you pay to providers in your plan's network applies to your "in-network" or "preferred" coinsurance maximum.
• Coinsurance you pay to providers outside your plan's network applies to your "out-of-network" or "alternate" coinsurance maximum.

Many costs don't count towards your coinsurance maximum

• Any costs that apply to your deductible
• Copayments (fixed dollar amounts) for doctor visits and other services
• Costs for services not covered by your plan

Other costs may be excluded by your plan; see your plan documents for details.