Health Insurance 101 We all know how complex and confusing health insurance can be. Below are some common terms and definitions to help you better understand what you have to pay and when. Please look at your plan documents outlining your WEA Trust health plan for specific plan information. ▸▸ Benefit year: A benefit year, also called a plan year, is a 12-month period during which you have insurance coverage. ▸▸ Premium: A premium is a monthly payment made to your insurance company for your health insurance coverage. You may pay the insurance company directly, or your employer may deduct money from your paycheck and pay the premium to the insurance company on your behalf. ▸▸ Co-pay: A co-pay is a fixed dollar amount that you pay for certain services (e.g. office visits, prescriptions) each time you have that service. ▸▸ Deductible: A deductible is the amount you pay to your doctor or pharmacy for covered services each benefit year before your WEA Trust health insurance begins to pay. ▸▸ Co-insurance: Co-insurance is a percentage of the cost of a covered service that you pay to your doctor. For example, if your co-insurance is 20% and your bill is $100, you pay $20 and WEA Trust pays $80. Your WEA Trust health plan pays the remaining share. You do not start to pay coinsurance until after you have finished paying your deductible.

Example: UP TO

$1,000

DEDUCTIBLE

YOU PAY

UP TO

YOU PAY

20%

$5,000

100%

OUT-OF-POCKET PLAN PAYS MAXIMUM

AFTER DEDUCTIBLE REACHED

80% COINSURANCE

AFTER OUT-OF-POCKET MAXIMUM REACHED

PLAN PAYS

100%

THROUGH END OF YEAR FOR COVERED SERVICES

▸▸ Maximum Out of Pocket Amount: The maximum out of pocket amount is the most money you will have to pay each benefit year for covered medical expenses as outlined in your plan document. This includes the amounts you pay for copays, deductibles, and coinsurance. It does not include your monthly premium. Once the amount of money you have paid equals your maximum out of pocket amount for that benefit year, your WEA Trust health plan will pay 100% of covered services for the remainder of the benefit year.

45 Nob Hill Rd, Madison, WI 53713 800.279.4000 WEAtrust.com

MPD 1242-0617

Health Insurance 101 - WEA Trust

For example, if your co-insurance is 20% and your bill is $100, you pay $20 and WEA. Trust pays $80. Your WEA Trust health plan pays the remaining share.

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