For HMOs, if you are referred to a specialist, make sure he or she is in your network. In some cases, you may have to pay the full cost. If you visit a doctor outside of your network, you may have to pay more for your care. These providers have agreed to work with your health plan to keep your costs down. Stay In Network With Provider Finder ®īefore you go for care, make sure you go to a doctor or hospital in your health plan network. Deductibles, coinsurance, copays and other expenses for in-network essential health benefits (EHBs) apply to the OOPM.įind examples of how your out-of-pocket maximum works with other costs, like your deductible and coinsurance. The amount you pay depends on your health plan and which doctor you see.Īlso called OOPM, this is the most you have to pay out of your own pocket for expenses under your insurance plan during the year. In most cases, it's a small amount, such as $20 for a doctor's exam. CopayĪ copay is a fixed dollar amount you may have to pay at the time you get care. If you haven't met your deductible, you must pay the entire amount.įind examples of how your coinsurance will work after you’ve met your deductible. If your coinsurance is 20%, you must pay $20 and the insurance plan pays $80. It applies after you meet your deductible.įor example, let's say it costs $100 to see your doctor. This way you keep your monthly costs lower by taking the chance that you may not need to pay your deductible.įind examples of how your deductible works with other costs, like your coinsurance and out-of-pocket maximum.Ĭoinsurance is the percentage of the cost that you must pay for a covered service. If you know you won't use your insurance often, you may want to choose a plan with a lower monthly premium and higher deductible. This means you'll pay more each month, but the amount you pay when you go to the doctor will be less over the course of the year. If you know you'll be using your insurance often, you may want to choose a plan with a higher premium and lower deductible. Tip for choosing your premium and deductible The lower the deductible, the higher premium. In most cases, the higher your deductible, the lower your premium. For example, if your deductible is $1,000, your plan won't pay for some services until you've paid $1,000. In most cases, it's paid monthly, but can be paid every 3 months or yearly.Ī deductible is the amount you must pay before the health plan starts paying for your covered services. For more information on your medical benefits, please contact Blue Cross Blue Shield using the number on the back of your UT SELECT medical card.The premium is the amount you (or your employer) pay for your health insurance plan whether you use medical services or not. Note: UT Health Physicians in San Antonio does not currently own a hospital, so this discount only applies to UT Health Physicians fees. Current coinsurance under the UT SELECT medical plan is 20%, but if you use a UT Health physician it is only 10%. Lower your coinsurance by using a primary care physician or specialist at UT Health Physicians. The copay for UT Specialist Providers is $40. Primary care copay for UT Providers is $20. Program Benefits Save $10 on CopaysĮach time you visit a primary care physician or specialist at UT Health Physicians, save $10 on your copay. UT System employees and retirees, along with their dependents, get discounts when they use UT providers or facilities with the UT SELECT medical plan. Discounts for UT System Employees who use UT Physicians
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