Choice Plus Coinsurance
In the Choice Plus plan, Banner option hospitalization will change from a copay to a coinsurance model: $100 deductible, 10 percent coinsurance with a $1,000 out of pocket maximum.
Banner’s Choice Plus medical plan includes three different ways for you to access care. Each of the three options has different arrangements for sharing costs.
The change in the 2013 plan is specific to the Banner Option of the plan, in which you access care through your Primary Care Physician (PCP) and other selected providers who are contracted with this option of the plan. The information given below applies to that level of the plan.
Here are three terms that are important.
- Deductible – This is an amount of money you are responsible for paying before the medical plan begins to pay. In 2013, the Banner Option of the Choice Plus plan will have an annual deductible of $100 for individual or $200 for family coverage, but this deductible only applies to inpatient or outpatient hospitalization at a Banner facility. There is no deductible for any other services in the Banner option.
- Coinsurance – This is the portion of charges you are responsible for paying after you have met your annual deductible. In 2013, there will be a 10 percent coinsurance on inpatient and outpatient hospitalization at a Banner facility under the Banner Option of the Choice Plus plan. There is no coinsurance on other types of services in the Banner option such as office visits or lab work.
- Out-of-pocket maximums – This is the maximum dollar amount that you will pay in deductibles and coinsurance during a plan year. For 2013, the out-of-pocket maximum for the Banner Option of Choice Plus will be $1000 for an individual or $2000 for a family.
Here’s an example of how this change in the Banner Option might impact you in 2013.
- We’ll start with the total costs for your care that the Banner hospital bills to your medical plan. Let’s say the total bill is $15,000.
- Since you are a member of the Choice Plus plan, and are using the Banner option in which providers have contracted directly with the plan, the bill is going to be discounted. In this example, let’s assume a discount of $5,000, so now your total hospital bill is down to $10,000.
- You are responsible for paying a $100 deductible for hospitalization; this deductible was likely already collected by Banner at the time you were admitted (much like your physician’s office collects your share of their payment at each visit).
- Since there is 10 percent coinsurance on hospitalization under the Banner Option, you will be responsible for 10 percent of the charges. Because you used the Banner Option, your 10 percent is based on the discounted bill of $10,000, not the full $15,000. That means you would be responsible for $1,000 in coinsurance (10 percent of $10,000). If needed, Banner’s financial services representatives will work with you to determine a payment plan, which may include taking deductions from your paycheck over a period of time.
- Remember that out-of-pocket maximum mentioned earlier? As an individual, your out-of-pocket maximum for the plan year under the Banner Option is $1000. That means you’ve now met the maximum for the year. If you were to be hospitalized a second time in 2013 using the Banner Option, you wouldn’t have to pay another $100 deductible, or any coinsurance, because you’ve already spent the $1000 maximum amount for the year.
- If you have family members enrolled in your plan, the $100 you paid for your deductible counts towards the $200 annual family deductible, and the $1000 you already paid counts against the $2000 annual out-of-pocket maximum for the family level of coverage.
Hopefully, this example helps you to better understand how deductibles and coinsurance work, and how the out-of-pocket maximum helps to limit the total dollars that you and your family pay during the plan year. Although only the Banner Option of the Choice Plus plan was discussed in this article, you can apply these same principles to the other options of Choice Plus or to the Select plans.