Coinsurance & Deductible - How a Plan Works?

person Hi,

I need some clarity on some details mentioned in the summary page for the fixed plans. It shows amt in these plans in the Co-Insurance section. What exactly does 100% covered amount mean? I pay the rest of what? Could you please shed light on this?

Thank you for contacting us at American Visitor Insurance for your visitor medical insurance needs!.

This is what we mean to say to the customers when it comes to the co-insurance.

There are 2 kinds of plans "Fixed" and "Comprehensive". The wording that you are seeing are for the Fixed plans which show up in yellow in the summary page. There is no co insurance for the fixed plans.

A fixed plan pays a set amount (variable by company and maximum amount) for each medical expense. If the customer is charged more than this amount, then they must pay the difference. All of that, is of course, after the deductible is met. Please understand the difference between Fixed and Comprehensive plans.

Please let us know if you need anything further.

person Hi,

Do i need to pay the deductable every time i go to doc visit? So my insurance will the rest of expenses?

Thank you for contacting us at American Visitor Insurance for your visitor medical insurance needs!.

It depends on the type of plan you buy. If it a "Per policy period" plan then you pay the deductible only once in the plan maximum lifetime.

If the plan is : Per injury/sickness" plan, then you will have to pay the deductible every time you visit the provider for each and every injury/sickness incident.

Please let us know if we can help you any further.

person Dear Madam,

I want to know how the co-insurance works? Is similar to a deductible, except that it is a percentage (20%) of the first $5000 costs, and it only applies if I use a hospital outside of their PPO networkof hospitals, is that correct? Sounds to me like the deductible is $1250 rather than $250 in that situation.

Do you have information about their PPO network, do they have hospitals throughout US?

Thank you for contacting us at American Visitor Insurance for your visitor medical insurance needs!.

Yes. The 20% co-insurance depends on the insurance plan you purchase.

In some plans, there is a 10% Co-insurance and in some others there is a 20% co-insurance. In some plans the entire 20% co-insurance is waived if you use a facility within the PPO network, and is charged only when you use a facility that is outside the PPO network. Details of the co-insurance can be reviewed by using our quote comparison tool.

This is applicable for the first $5,000 of the expense incurred by you.

For Example:
If you incur an expense of $3,000, this is how the co-insurance and deductible apply:

Expense = $3,000

Deductible(This is the amount that you pay) = $250

Final Expense amount that the Insurance Company will pay = $3,000 - $250 = $2,750.
Now, the 20% co- insurance will be applied on $2,750 when you receive treatment outside of PPO. So, 20% of $2,750 is 550.

Final expense that Insurance company pays = $2,200

The amount that you pay = $800

The PPO network links for both the plans are as below:

Atlas America Provider Network

Patriot America Provider Network

You can also buy Atlas America Insurance and Patriot America Insurance online.

Please let us know in case you have any questions

person Hi,

I am trying to make a purchase of travel insurance. We are Spanish and traveled 19 days to California. My question is that when filling the coverage you desire, 500,000 dollars, displayed above: Deductible per Certificate Period. I do not know what this is? Help me please?

Thank you for contacting us at American Visitor Insurance for your visitor medical insurance needs!.

Deductible is the amount that will be deducted from the medical expense incurred when you come across an injury or sickness. From the total amount of the expense you pay the deductible and the rest of the expense will be taken care of by the insurance company.

For ex: If your policy has a deductible of $100 . Then, if you come across an injury or sickness and the bill or the expense is $2000 for example.

Then you will have to pay the deductible $100, then the remaining expense is $1900 will be paid by the insurance company.

If there is a co-insurance amount associated with your plan, then this is how it works:

From the $1900 of expense that the insurance company has to pay, if the coinsurance percentage is 80%, then 80% of $1900 will be paid by the insurance company and remaining 20% has to be paid by the insured (which is you).

Let us know if you need any further clarification.