Common payment terms

Once you begin using your healthcare plan, it’s important to understand terms about payments and coverage, so you can get the most out of your plan. Listed below are definitions to common terms, as well as examples.

As always, if you have questions about payments, deductibles or providers, find helpful resources on MyHumana.com.

A Humana member stands at a hospital counter talking to a hospital employee about common payment terms.

Definitions and terms

The key terms below and their definitions may help you understand costs.

Claim

Another word for a claim is a bill. Your hospital or doctor’s office will send this bill to Humana as a request for payment for services provided to you. After Humana handles your claim, you'll get an Explanation of Benefits (EOB) showing what was paid and what you may still owe.

Claim payment

If you paid for services from your provider, ask us to reimburse you. You may request reimbursement by mailing a copy of your Humana member ID card and the provider’s bill to the claims address written on the back of your card. Make sure the bill shows the patient's name and Humana member ID number.

Coinsurance

Coinsurance is a payment you may still be responsible for after you meet any deductible. It is a common percentage covered in most any plan. For example, if your health plan pays 70 percent of the cost, your coinsurance payment is the remaining 30 percent.

Copayment

A copayment, or copay, is the amount you pay to a healthcare provider or pharmacy at the time of service. Copayments vary depending on your plan and the services you receive. For example, you may have a $40 copayment for a doctor's office visit.

Deductible

Your deductible is the amount you pay toward certain medical expenses before your insurance plan starts paying any of the costs. Check your plan coverage details to see what deductibles you have. These range from medical care to prescription drugs.

The amount of out-of-pocket payment also depends on whether you receive care from a doctor or hospital included in your plan. If your plan covers expenses for care outside of your Humana provider network, the plan will have separate deductibles for in- and out-of-network care.

Fortunately, although you must meet a deductible before your plan pays, you’re not paying the full price for services. You’re paying a lower amount Humana has negotiated for you. For example, let’s say a patient has a $3,000 deductible and has only paid $400 in medical expenses. The patient goes to his or her in-network doctor for an illness. The doctor submits a claim to Humana for $95; however, Humana has a contract with the doctor. The patient is only responsible for $60. The patient will receive an Explanation of Benefits (EOB) to explain this negotiated rate.

Out-of-pocket maximum

With most Humana plans, there is a maximum amount that you’ll be required to pay out-of-pocket. Deductibles and copayment go toward this out-of-pocket maximum. Once the total amount you’ve paid reaches the out-of-pocket maximum, your plan pays 100 percent of covered services. Check your plan on Humana.com for this protection.

Payment to providers

Ask your doctor or hospital whether they accept cash, check, or credit card. Pay these providers for medical care or prescription drugs in the method they prefer. In addition, if you have a health savings account (HSA), you can use it to make payments to providers.

Premium payments

A premium payment is the cost of your healthcare plan to keep coverage active whether you use it or not. It is typically billed monthly; however, some plans offer other options. Choose an individualized plan and a rate that’s right for you. Pay your premium at MyHumana.com.

Provider

A provider is a person or place that gives you medical care. Providers include doctors, hospitals, retail clinics, urgent care centers, and other healthcare professionals and facilities. You can find a provider in your network using the Find a Doctor link on MyHumana.com.

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