Coinsurance
The percentage of a covered medical bill an employee pays after meeting their deductible, with the plan covering the rest.
Once an employee has met their deductible, most plans don’t cover 100% of remaining costs right away — instead, the employee and the plan split the bill according to a coinsurance percentage (commonly something like an 80/20 or 70/30 split, plan-dependent) until the employee hits their out-of-pocket maximum for the year.
How it differs from a copay: a copay is a flat dollar amount for a specific type of service (say, a set fee for a primary care visit), while coinsurance is a percentage of the total bill — which means coinsurance costs can vary a lot depending on how expensive the underlying service turns out to be.
Where it fits in the cost-sharing sequence: deductible → coinsurance → out-of-pocket maximum. Once total spending (deductible plus coinsurance) reaches the plan’s out-of-pocket max for the year, the plan covers 100% of additional covered costs for the rest of the plan year.
Related Terms
Have questions about how this applies to your renewal?
Talk to a group health insurance broker who specializes in your situation.