I M P O R T A N T D E F I N I T I O N S 1 P R E M I U M D E D U C T I B L E C O P A Y The amount you pay out of your paycheck to keep your health insurance active . A fixed amount for a covered health care service , such as a physician office visit or a prescription . The amount an individual or family pays out of pocket before health insurance begins to cover the cost of medical expenses , typically lab work or tests and hospital visits . C O I N S U R A N C E The percentage of cost of a service that you pay after you meet your deductible ; for example , if your plan has 20 % coinsurance for a service costing $ 100 , you pay $ 20 . O U T - O F - P O C K E T M A X I M U M The most you will pay for covered services in a plan year . Your copay , deductibles and coinsurance all count toward this maximum .