There are several cost-sharing methods you'll want to know in order to fully understand your health benefits.
It’s important to note that Sana’s medical plans cover a range of healthcare services and prescription drugs. If a service is eligible, 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 or accessed through a trusted partner when applicable.
Below is a brief overview of how some common cost-sharing types work and where it applies.
1. Preventive Care
Services that qualify as preventive care and preventive medications are 100% covered by Sana. This means you are not responsible for any cost-sharing, such as a copay, deductible, or coinsurance amount.
2. Sana Care & Trusted Partners
Services accessed through Sana Care or Trusted Partners (such as virtual primary care, mental health, or specialized care programs) offer reduced or $0 cost-sharing before your deductible is met depending on your plan.
3. Copays
A copay is a small, fixed dollar amount you're responsible for paying directly to the provider at the time of your visit, regardless of whether you’ve hit your deductible.
- Select services qualify for copays depending on your specific Sana plan.
- Copays do not apply toward your deductible, but they will accumulate toward your Out-of-Pocket Maximum (OOPM).
4. Deductibles
The initial dollar amount you are personally required to pay out-of-pocket before your plan begins paying toward eligible medical services.
- All Sana plans have deductibles set for both individual and family coverage (if applicable).
- Once you pay your deductible, your plan begins to share costs by making payments on your behalf, though you'll still pay coinsurance.
- To view your real-time deductible progress, log in to your Sana Member Portal and refer to the Medical Spend section on your Dashboard.
5. Coinsurance
In general, coinsurance is your cost-sharing percentage share of the adjusted total (the negotiated price) owed for an eligible service after you have met your deductible. Services subject to the deductible are also subject to coinsurance. Coinsurance percentages vary by plan tier.
6. Out-of-Pocket Maximum (OOPM)
The Out-of-Pocket Maximum is the absolute cap on what you are required to pay for eligible services over the course of a plan year.
- All plans feature individual and family OOPM limits. (If applicable)
- All member cost-sharing accumulates toward your OOPM (including deductibles, coinsurance, and copays).
- Once your out-of-pocket maximum is reached, Sana covers 100% of eligible claims and prescriptions for the remainder of the plan year.
Where to Find Your Specific Plan Details:
To check which specific services qualify for copays, verify your deductible amounts, or view your official Summary Plan Description (SPD), log in to your Sana Member Portal and select the Documents tab.
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.