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Understanding co-insurance
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Co-insurance means you share the cost of your health care with LSU First after you meet your deductible. Co-insurance is a percentage that you pay after your deductible is exceeded, up to the Out-of-Pocket Maximum.
The chart below illustrates an LSU First Member with Option 1, Employee Only coverage. It compares what you would pay when using First Choice, In-Network, and Out-of-Network providers.
Out-of-Pocket Maximum
To protect you there is a maximum dollar amount of co-insurance you are required to pay. This is referred to as the Out-of-Pocket Maximum, which is based on the plan option and coverage level selected, as well as the network status of the provider you choose. Once your out-of-pocket expenses equal the maximum out-of-pocket figure, LSU First assumes responsibility for 100 percent of any additional costs.
For example, if you have “Option 1, Employee Only Coverage,” (shown in the chart), your out-of-pocket maximum for in-network providers would be $1,000.
Health care expenses of all family members contribute to the annual out-of-pocket maximum. This means that the costs of only one family member could meet the out-of-pocket maximum. In that case, claims for all other family members would be paid at 100 percent by LSU First.
LSU First co-insurance cross accumulates between First Choice, CIGNA Open Access Plus providers and Out-of-Network providers. That means all co-insurance paid by any provider would contribute to both your in-network, out-of-network, and out-of-pocket maximum costs.
Covered Expenses & Maximum Reimbursable Charge
Non-covered services are your responsibility to pay. Payments for non-covered services do not contribute toward your deductible or co-insurance.
The Maximum Reimbursable Charge is an amount set by CIGNA for each specific service. If you receive services from an out-of-network provider, any charges above CIGNA’s maximum reimbursable charge would be your responsibility and would not count toward your out-of-pocket expenses.
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