Sometimes understanding all the terms when trying to choose a medical plan can be a frustrating exercise. How can you fully compare plans, much less choose the best one for your situation, when you’re not even sure what all the words mean? Here are some explanations for five terms that will help you pick the right plan:

1. Deductible: This is the set amount you will have to pay out of pocket before the plan will begin paying on your behalf. Once this set limit is reached, your plan kicks in, paying a predetermined percentage of all subsequent eligible medical costs. Generally, the higher the deductible, the lower the monthly premium for the plan.
2. Copay: This is the fee you pay for prescriptions, regular doctor or specialist visits. Copays can vary greatly. For example, GuideStone’s PPO plans have doctor visit copays ranging from $20–$45, depending on the type of plan and whether you’re visiting your regular doctor or a specialist. Copays do not count toward your deductible or out-of-pocket maximum amounts.
3. Coinsurance: This is the predetermined percentage — usually between 50–90% depending on the plan — of your medical costs that the plan pays once you have met your deductible. (GuideStone’s Health Saver 2600, a federally qualified High Deductible Health Plan, pays 100% of eligible in-network charges once you’ve met your deductible.) For example, let's say your annual individual deductible amount is $1,000 and your coinsurance is 80%. Once you have paid for $1,000 in covered medical costs yourself, your plan’s coinsurance begins paying 80% of eligible medical costs over the $1,000 deductible that you’ve already paid. You would pay the remaining 20% of the costs incurred above your deductible. Doctor visit copays generally do not count toward your deductible.
4. Out-of-pocket maximum: After your deductible has been met, this term refers to the most you will have to pay once your coinsurance kicks in. When you have reached this “out-of-pocket maximum” amount, your plan typically pays 100% of any additional eligible medical expenses you might incur. Remember, since doctor visit copays generally don’t count toward your deductible, you may still be required to pay those even after meeting your annual out-of-pocket maximum. For example, if your plan’s coinsurance covers 80% of medical costs (after you’ve met your deductible), then you pay the remaining 20% of those costs. Once your 20% portion of the coinsurance reaches your plan’s specified out-of-pocket maximum, the plan would then pay 100% of all subsequent eligible medical expenses.
5. Family deductible: This is the set dollar amount that a participating family must pay before coinsurance kicks in. Generally, one family member cannot contribute more than the “individual deductible” amount toward the family deductible. This means that although the plan starts paying its coinsurance percentage for the one family member who meets his deductible, the other members must together meet the remainder of the family deductible before the plan pays toward health care for the whole family.

So, if your plan has a family deductible of $2,000, no family member could count more than $1,000 (which is the “individual deductible” amount) of his/her medical expenses toward the family deductible amount. For a family of four, the other three members’ expenses would combine to meet the remaining $1,000 of the family deductible.

Understanding the details of your medical plan options is the first step in selecting the best plan for you. For additional help in choosing the GuideStone PPO plan that best meets the needs of your family, browse our Web site or call 1-888-98-GUIDE (1-888-984-8433). One of our Customer Relations specialists will be glad to help. To determine your monthly rates for any of our PPO plans, use  the "Get A Quote" tool.

GuideStone Financial Resources of the Southern Baptist Convention welcomes the opportunity to share this general information. However, this article is not intended to be relied upon as medical advice, diagnosis or treatment.