Helpful terms you should know

Coinsurance: A fixed percentage you pay for a medical service or prescription after your deductible is met. Example: 10% of an $85 office visit.

Copayment: A fixed amount you pay for a medical visit or prescription. Example: $20 office visit copayment or $10 copayment for a 30-day generic prescription

Deductible: Similar to homeowners or auto insurance, it’s the amount you pay for covered health care services before your health insurance begins to pay. Deductibles reset on Jan. 1 and run through Dec. 31.

In network: MESSA members have access to the largest provider network in Michigan. In-network providers and facilities agree to accept an approved amount as payment in full, meaning you are responsible only for your deductible, copayments and coinsurance.

Member/subscriber/enrollee: These terms are interchangeable and refer to the person who has the MESSA health plan in their name.

Out of network: This refers to providers and facilities who are not in MESSA’s network. Out-of-network services have higher deductibles and coinsurance. Out-of-network expenses do not count toward your deductible or out-of-pocket maximum.

Out-of-pocket maximum: The most you pay in a calendar year for in-network, covered medical services and prescriptions, including deductible, copayments and coinsurance.

Premium: The total cost of your health plan. You pay a share of the premium, which is deducted from your paycheck. Your employer pays the full premium to MESSA.