There are several cost-sharing methods you'll want to learn in order to fully understand your health benefits. We're here to simplify everything.
It’s important to note that Sana’s medical plans cover a range of healthcare services and prescription drugs. If a service is covered, it will either be subject to a copay or the deductible and coinsurance. The only exception to this is if it’s considered preventive care. In this article, we will explore what it means for a member if a service is preventive versus subject to a copay versus subject to the deductible and coinsurance.
Preventive Care
Services that qualify as preventive care & preventative medications are 100% covered by Sana. This means that a member is not responsible for any cost-sharing, such as a copay, deductible, or coinsurance amount.
Copays
The small fixed amount you're responsible for paying directly to the provider at the time of your visit regardless of whether or not you’ve hit your deductible. To find what covered services qualify for a copay, refer to the Summary Plan Description (SPD) or Summary of Benefits & Coverage (SBC) in your Documents center.
- Select services qualify for copays, depending on your Sana plan
- When a copay is paid, Sana covers 100% of the visit after that, excluding diagnostic services
- Copays do not apply to your deductible but will apply to your Out-of-Pocket Max (OOPM)
Deductibles
The amount you're personally required to pay before your plan will start paying. To find what covered services are subject to your deductible, refer to the Summary Plan Description (SPD) or Summary of Benefits & Coverage (SBC) in your Documents center.
- All Sana plans have deductibles set for both the individual and the family (if applicable)
- Once you pay your deductible, your plan begins to make payments on your behalf, though you'll still pay coinsurance
- To view your deductible progress, log in to your Sana portal and refer to the Medical Spend section on My Dashboard
Coinsurance
In general, this is the payment you're responsible for after you pay the deductible. It is a percentage of the adjusted total (i.e. the negotiated price) owed for the service. Services subject to the deductible are also subject to coinsurance.
- Members of H plans are responsible for 0% after the deductible.
- Members of S (Superior) plans are responsible for 10% after the deductible.
- Members of P (Premium) plans are responsible for 20% after the deductible.
- Members of E (Essential) plans are responsible for 30% after the deductible.
- Members of B (Basic) plans are responsible for 40% after the deductible.
- Members of C (Core) plans are responsible for 50% after the deductible.
Out-of-Pocket Max (OOPM)
The OOPM is the maximum amount you're required to pay for covered services over the course of a year.
- All plans have an OOPM set for both the individual and the family (if applicable)
- Once the out-of-pocket max is reached, the plan will cover 100% of claims and prescriptions for covered services for the remainder of the plan year
- All member cost-sharing will accumulate towards your OOPM (i.e. deductible, coinsurance, and copays)
- To view your OOPM progress, log in to your Sana portal and refer to the Medical Spend section on My Dashboard
Have questions? We've got you covered.
- Log in to view account details.
- Search FAQs in our Help Center.
- Connect with Customer Support directly through the chat icon on most Sana pages or call us at (833) 726-2123 Monday through Friday, 7 AM to 7 PM Central.