What is the Blue Cross Definition of a Co-pay Deductible?

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Blue Cross is a company that provides health insurance coverage throughout the United States. The company operates under different names in several states, but all Blue Cross companies operate under the same umbrella. Many employers offer Blue Cross health insurance as part of an employee's benefits package. Additionally, Blue Cross also sells private health insurance policies that do not require an affiliation with a group plan. A co-payment is a flat amount paid by the insured to receive services under the insurance policy. The amount of the co-payment varies depending on your specific insurance policy. A deductible is a flat amount of money you must pay prior to making any claim against the insurance policy.

Policy

  • You should always fully understand the coverage offered under your health insurance policy. Health insurance policies are often confusing. Three of the most important aspects of your insurance policy are your out-of-pocket maximum, your yearly deductible amount and specific co-payment requirements. Having a full understanding of these terms, and how they apply to your specific insurance policy, will keep you informed about the expenses you can expect from your health insurance policy.

Out-of-Pocket Maximum

  • The out-of-pocket maximum is the maximum amount of money you will have to pay in a calendar year before Blue Cross starts covering 100 percent of your medical expenses. This amount varies depending on your specific insurance policy. The out-of-pocket maximum includes co-payments you make under your policy, prescriptions, deductibles and any non-covered, eligible expenses made during the calendar year. You add up all of your individual out-of-pocket medical expenses to determine your total cost for the year. If this cost exceeds your out-of-pocket maximum, Blue Cross will reimburse you for the overage.

Deductible

  • The policy deductible is the amount of money you will have to pay for medical expenses prior to Blue Cross providing coverage under your policy. Generally, the higher your insurance premium, the lower your deductible. Once you have exceeded your yearly deductible amount, Blue Cross will begin to cover your medical expenses subject to the terms of your individual insurance policy. On most policies, you will still have out-of-pocket costs for co-payments and other items after paying your yearly deductible amount.

Co-payment

  • The co-payment is a fixed amount or percentage that you pay for medical expenses including office visits to doctors, emergency room visits and prescription medication coverage. The co-payment amount or percentage never changes, and the co-payment applies for the whole year after reaching your deductible until you reach the out-of-pocket maximum for the year. Your specific co-payment amounts or percentages vary based on your specific Blue Cross health insurance policy.

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