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- 1). Locate the schedule of benefits. This sometimes may be called a summary of benefits. This schedule or summary of benefits contains a chart of all the services covered and how much of the cost is covered under the group health plan.
- 2). View the deductible listed on the schedule of benefits. The deductible is the amount of money that must be paid out of the user's pocket before the group insurance plan helps cover a medical procedure.
- 3). Notice the section labeled coinsurance. Coinsurance is the amount required to pay for services, after the deductible has been paid. Coinsurance is often described using a percentage. For example, if it says 80 percent, this means you pay 20 percent toward the charges for a service and the insurance company pays 80 percent.
- 4). Understand the maximum out-of-pocket section. The maximum out of pocket amount is the total amount you must pay (deductible plus coinsurance) in medical expenses for the year before the group insurance coverage pays any additional expenses that year at 100 percent.
- 5). Read over the schedule of benefits carefully. This will outline what type of procedures are covered under the insurance plan and how the plan pays for procedures. For instance, routine office visits may be covered by only a co-payment--a predetermined flat fee for a service, whereas going to the emergency room requires meeting the deductible first before group insurance helps pay towards medical bills.
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