Cigna Copays, Deductibles, and Coinsurance Definitions
In order to make informed choices about your healthcare and associated expenses, it is important to understand the terminology associated with dental insurance. If you are a member of Cigna insurance and have come across terms like copays, deductibles, and coinsurance, it’s normal to be uncertain what those words exactly mean. To learn more about what copays, deductibles, and coinsurance mean and why it’s important information to know, please refer to the following.
Copays
Copay (copayment) is the predetermined amount you will be responsible for paying for a particular service or treatment. For instance, if your Cigna dental plan indicates a copay of $20 for a routine dental examination, you will pay this fee during your visit, regardless of the total examination cost. The remainder of the expense will then be covered by your insurance. The amount of your copay and coverage will vary, depending on which plan you are under and what type of procedure is being performed, which can result in various copays for preventive treatments, basic procedures, and major dental operations. Generally, preventative services have low copays or may be covered completely, whereas intricate procedures (dental crown, root canal) have higher copay amounts.
Deductibles
Your deductible is how much you are responsible for paying out of your own pocket before your insurance coverage activates. For example, if your Cigna dental plan stipulates a deductible of $100, you will be responsible for covering dental services until you reach that total. Any cost incurred beyond this deductible will be covered by Cigna.
Unlike copays, which are due when services are provided, deductibles can accumulate throughout the year across various visits and treatments. Please be aware that not all services are subjected to this deductible. For example, preventive services will not typically require you to fulfill the deductible before coverage applies; however, for basic and major services, it is important to have a clear understanding of your deductible so you can make the necessary financial planning decisions to cover your care.
Coinsurance
Coinsurance refers to the percentage of costs for a covered service that you are responsible for once your deductible has been met. Cigna will cover a specific percentage of the remaining costs and you will be responsible for the remainder. As an example, if you have a coinsurance rate of 20% for a procedure that costs $1,000, you will be responsible for paying 20% of that amount ($200) and Cigna will cover the remainder ($800). Coinsurance rates can vary depending on the service received, with preventative services typically having a lower coinsurance percentage and major procedures with higher rates.
Choosing Your Plan
Hopefully having a better understanding of what copays, deductibles, and coinsurance are, you feel better equipped to determine what plans is right for you and how to budget for potential dental needs accordingly. By having a clear understanding of these concepts, you can better manage your dental care expenses and ensure you maximize your insurance benefits to receive the care you need.
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