What is the term for the pre-determined amount paid by the member before insurance coverage begins?

The term for the pre-determined amount paid by the member before insurance coverage begins is called a deductible. A deductible is a specific dollar amount that a policyholder must pay out-of-pocket for healthcare services before their insurance plan starts to pay for those services. This mechanism is designed to share costs between the insurance provider and the insured, encouraging responsible healthcare usage.

In contrast, a premium refers to the regular payment made to maintain the insurance policy, while a co-payment is a fixed amount that the insured pays for specific services at the time of receiving care. Out-of-pocket expenses typically encompass both deductibles and co-payments, as well as costs not covered by insurance, which is distinct from the definition of a deductible. By understanding these terms, one can better navigate the complexities of health insurance and its associated costs.