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Key terms in your health plan explained

Health providers, and the majority of insurance companies, tend to use technical terms to explain the details of their plans. This can be confusing, especially if you're new to health insurance, so we've explained what each of our most common terms mean below for you.

What’s a deductible?

A deductible is the amount you pay towards covered medical expenses before your health insurance begins covering your costs. Many companies opt for deductible options to reduce the overall cost of their insurance.

Once you have met your deductible, Integra Global will cover all costs for treatment, as per your table of benefits, for the remainder of your policy year.

Please note that some of your cover is exempt from the deductible, such as wellness and vision care benefits, so please refer to your table of benefits for details.

What is co-payment?

Co-payment is the percentage of costs you are responsible for covering in your plan, after your the deductible has been taken into account.

Integra Global pays 100% of costs for the majority of benefits. However, some benefits are covered at 90%. For these benefits, the member will cover the remaining 10% of costs. Please refer to your table of benefits to see which benefits and treatments are subject to a co-pay.

 

 

What’s an out of pocket maximum/limit?

An out of pocket maximum or limit improves your benefits by limiting the portion of co-payment you are liable to pay in a policy year. Essentially an out of pocket limit caps your responsibility of payment costs.

The maximum individual out of pocket on our group plans is $1,000 per policy year. Once this limit has been met, your covered medical expenses are paid at 100%.

This essentially means you will never pay more than USD $1,000 out of pocket to cover your medical costs.

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