The share of a medical bill you are required to pay under a traditional insurance or a mixed plan after the deductible has been paid. For example, if the health plan pays 80 percent of the cost, the 20 percent you pay is the co-insurance. A fixed amount you pay for services under your health plan. This feature is more common with traditional insurance. Health services not covered by your health plan, or specific circumstances under which your plan will not pay for services.
Typical exclusions are cosmetic surgery and going to the emergency room for non-emergency care.
A primary care physician who coordinates all medical care for a patient and determines whether services such as tests or referral to a specialist are necessary. Health plans that provide comprehensive health care services to members for a fixed fee. A traditional insurance plan that reimburses for medical service provided to patients based on bills submitted after the services are rendered. The doctors, clinics, hospitals and other medical providers that a health plan contracts with to provide health care to its members. Members are generally limited to network providers for full coverage of their health costs.