What is a coinsurance clause?

A coinsurance clause is a provision in a health insurance policy that requires the insured to pay a portion of the cost of a particular service or procedure. It is usually expressed as a percentage of the total cost. For example, if the coinsurance clause requires the insured to pay 20% of the cost of a procedure, the insurance company will pay 80%. In Washington, coinsurance clauses are regulated by the Washington State Office of the Insurance Commissioner (OIC). The OIC requires health insurance plans to offer minimum coinsurance limits to ensure that the policyholder pays an acceptable portion of the cost of care. The limits are based on the type of service or procedure being provided. For example, the OIC may allow a policy to have a coinsurance limit of 70% for hospital stays, but require that the coinsurance limit for home health care services is only 10%. The OIC also requires insurance companies to clearly explain the coinsurance clause in the summary of benefits provided to customers. This is to ensure that customers understand the costs they will incur when receiving services. By understanding the coinsurance clause, policyholders can make informed decisions about the best coverage options for their needs.

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What is a coinsurance clause?

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