Copays, Deductibles, Coinsurance, and Out of Pocket Max

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. 

Preventive Care

Services that qualify as preventive care are 100% covered by Sana with $0 cost-sharing

The small fixed amount you're responsible for paying directly to the provider at the time of your visit

  • 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
  • Check your plan to see which services qualify for copays
  • Copays do not apply to your deductible but will apply to your Out-of-Pocket Max (OOPM)

The amount you're personally required to pay in claims before Sana will start paying claims

  • All Sana plans have deductibles set for both the individual and the family (if applicable)
  • Once you pay your deductible, Sana begins to make payments on your behalf, though you'll still pay coinsurance

In general, this is the payment you're still responsible for on all claims after you pay the deductible

  • Members of H plans are responsible for 0% after the deductible, and 100% before 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 maximum amount you're required to pay in claims, copays, and coinsurance over the course of your plan year on covered medical costs

  • All plans have an OOPM set for both the individual and the family (if applicable)
  • Once the out-of-pocket max is reached, Sana will cover you at 100% of claims and prescriptions for the remainder of the plan year
Have questions? We've got you covered.

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  • 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.