Insurance for New Jersey Drug & Alcohol Rehab

This is the amount you pay for covered health care services in a given plan year before your insurance starts to pay for them. For example, if you have a $3,000 deductible, you pay for the first $3,000 of covered services yourself. Once you’ve spent $3,000 on covered health care services, you only have to pay coinsurance and copayment costs — your health care plan will cover the rest.

A copayment is the fixed amount you are required to pay for a covered health care service, like a doctor’s office visit or a trip to the emergency room. Copayments may take effect before or after your deductible is paid, depending on your health insurance plan. This information is not shown on our health insurance verification form.

Your coinsurance fee is the percentage of the cost of a covered health care service that you must pay once your deductible is paid in full. For example, if you’ve paid your deductible, the allowed amount for a doctor’s visit on your plan is $100, and your coinsurance is 20%, you will pay 20% of $100, or $20.

This is the maximum amount of money you are required to pay for covered services in a given plan year. Once your out-of-pocket maximum amount is spent on deductibles, copayments and coinsurance fees, your health care plan pays 100% of any additional costs of covered health care services.

This is the day your insurance company begins to help pay for your health care costs. Enrollment in a health insurance plan must be done either during the open enrollment period, usually held for a set amount of time once a year, or during a special enrollment period. Special enrollment periods begin after a qualifying event, like marriage, the start of a new job, the birth of a baby or the loss of health care coverage, and usually last for about 90 days. Your policy effective date is determined after you’ve enrolled, and usually falls a few weeks or months after your initial enrollment date.