Coinsurance is the percentage of medical costs a consumer is responsible for paying after meeting their deductible. Normally, this financial lever is associated with a Preferred Provider Organization (PPO), a health plan that gives members the choice of in- and out-of-network providers and doesn’t require designation of a primary care doctor. For example, your coinsurance level in-network might be 100%, which means plan members are not responsible for expenses beyond their deductible. When they seek care from an out-of-network provider, members may have a coinsurance level of 80%, which means they will be responsible for 20% of medical costs up to a coinsurance limit, such as $5,000, or a maximum of $1,000 in out-of-pocket costs. This type of plan design would be called 100/80 coinsurance with a $5,000 coinsurance limit.

In the early stages of your CDHP design and adoption, you might want to use the 100/80 design, so that your members have one less level to learn. As you and your employees become more comfortable with the plan, you can move this lever down and reduce premium costs by introducing additional out-of-pocket responsibility in the form of coinsurance, such as 90/70, or 10% member responsibility above the deductible.

CDHPCoach’s Storage Facility, where the Coach has organized and compiled a vast amount of tools and resources for you to access.

Housed here are key components and information within the book, Bend the Healthcare Trend which was the impetus behind the CDHPCoach.