Wyoming Educators' Benefit Trust

Frequently Asked Questions

Subscriber Liability

What is the definition of subscriber liability?

Subscriber liability refers to any expenses a cardholder is responsible for, such as a deductible, a co-payment, coinsurance, a sanction or a charge for a non-covered service.

What is a deductible?

The deductible is the amount a cardholder pays before his or her health plan begins to pay for covered services. Deductibles are on a calendar year basis, and start over each January.

What is a Co-payment?

A co-payment is a fixed amount or a percentage of the approved amount a cardholder must pay for a covered service.  Please note: the $30 copay on the $1,000 option does not apply to the deductible.

 

What is Coinsurance?

 

Coinsurance is a term used by the Health Care Financing Administration to refer to the percentage of the Medicare approved amount that a beneficiary is responsible for paying.

   After the deductible is met, the plan will pay 80% and the subscriber will pay 20% up to $5,000.

 

What about payment on a non-covered services?

 

If a service is not covered under your health benefits plan, you must pay for it.

   This amount will not go towards any out of pocket maximum