What provision allows for the sharing of expenses between the insured and the insurance company?

Coinsurance is the provision that facilitates the sharing of expenses between the insured individual and the insurance company. Under a coinsurance clause, after the insured has met their deductible, they will share the costs of covered healthcare services with their insurer at a specified percentage. For instance, if the coinsurance is set at 80/20, the insurance company pays 80% of covered expenses, while the insured is responsible for the remaining 20%. This arrangement not only helps manage healthcare costs but also incentivizes insured individuals to seek services wisely, as they are responsible for a portion of the expenses.

Deductibles refer to the amount the insured must pay out-of-pocket before coverage kicks in, whereas copayments are fixed amounts paid for specific services at the time of care. The out-of-pocket maximum is the cap on the total amount the insured would have to pay in a year, after which the insurance covers 100% of expenses. While all these terms involve cost-sharing aspects, coinsurance specifically denotes the ongoing sharing of costs beyond the initial deductible.