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Back 2 Basics - Glossarry

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Back 2 Basics - Glossary

回到基礎–詞彙表






1) Coinsurance

Your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductible you owe. For example, if the health insurance plan’s allowed amount for an office visit is $100, and you have met your deductible for the year, your coinsurance payment of 20 percent would be $20. The health plan pays the rest of the allowed amount.

1)共同保險

您所承保的醫療保健服務成本中的份額,以服務允許的金額的百分比(例如20%)計算。 您需要支付共同保險費以及您需付的任何自付額。 例如,如果健康保險計劃允許的門診金額為100美元,而您已滿足當年的自付額,則共同保險金的20%為20美元。 健康計劃將支付剩餘的允許金額。



2) Copay

A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.

Let's say your health insurance plan's allowable cost for a doctor's office visit is $100. Your copayment for a doctor's visit is $20.

If you've paid your deductible: You pay $20, usually at the time of the visit.

If you haven't met your deductible: You pay $100, the full allowable amount for the visit.

Copayments (sometimes called "copays") can vary for different services within the same plan, like drugs, lab tests, and visits to specialists.

Generally, plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.

2)共付額

在支付自付額之後,您還需要為受保的醫療服務支付固定金額(例如20美元)。

假設您的健康保險計劃中允許的醫生就診費用為$ 100。 您就醫的共付額為20美元。

如果您已經支付了自付額:您通常在就診時支付20美元。

如果您未達到自付額:您將支付100美元,即就診的全部金額。

共付額(有時稱為“共付款”)對於同一計劃中的不同服務可能會有所不同,服務例如藥物,實驗室檢查和專科醫生出診。

通常,每月保費較低的計劃的共付額較高。 每月保費較高的計劃的共付額通常較低。


3) Deductible

The amount you owe for health care services your health insurance plan covers before your plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you have met your deductible for covered health care services. The deductible may not apply to all services.


3)免賠額

免賠額是在健康保險計劃為您付款之前,您應為保險計劃支付的醫療保健服務欠款額。 例如,如果您的自付額為$ 1,000,那麼您必須滿足自付額才能享受承保醫療服務,您的計劃才會支付任何費用。 免賠額可能不適用於所有服務。



4) Maximum Out-of-Pocket

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100 percent of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance plan doesn’t cover. Some health insurance plans don’t count all of your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and Children’s Health Insurance Program, the limit includes premiums.

4)最大自付費用

在您的健康保險或計劃開始支付保單金額允許範圍內的100%之前的保險期內(通常是一年),您支付的最高金額。 該限額永遠不包括您的健康保險計劃涵蓋範圍外的保費或餘額結算費用。 某些健康保險計劃並未將您所有的共付額,免賠額,共同保險付款,網絡外付款或其他費用都計入此限額。 在白卡和兒童健康保險計劃中,該限額包括保費。


5) Covered California

Covered California is a free service that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place where you can get financial help when you buy health insurance from well-known companies. That means when you apply, you may qualify for a discount on a health plan through Covered California, or get health insurance through the state’s Medi-Cal program.

5)加州健保

加州健保是一項根據患者保護與平價醫療法案將加州人與各大健康保險公司聯繫起來的免費服務。 當您從知名公司購買健康保險時,這是您唯一可以獲得財務幫助的地方。 這意味著當您申請時,您可能有資格通過加州健保獲得醫療計劃的折扣,或者通過該州的白卡計劃獲得醫療保險。



Source文章來源: https://www.coveredca.com/glossary/

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