Summary of Benefits

Understanding Your Insurance Policy

Summary of Benefits

It is very important to understand what your insurance provides coverage for. If not, there could be a significant cost to you for services received. Depending on the type of policy you purchase, the types of services that are covered can vary greatly. To avoid high medical bills, you should review your summary of benefits. This will have information on covered services and how much they will cost you as the member. Although, much of the information within is industry specific and speaking with someone in our office can help you understand what you are buying.


Most summary of benefits for health insurance Nevada plans have similar formats across different insurance companies. The first information you will usually see is the type of network your policy uses. Using doctors that are in-network, will help you pay the least amount of money for seeing a provider. Networks and the doctors and facilities within can be very different between insurance companies and types of policies. You should also see your deductible and maximum out of pocket on the first pages as well. The maximum out of pocket amount is one of the most important numbers on the page. This is the total cost you can spend in a policy year on medical services. After you reach this mark, the insurance company completely covers you for eligible services for the rest of the year.

Copays and Coinsurance

Further down on the summary of benefits will show you the costs a member will pay for specific services. These amounts may be a single figure which is your copay. For example, a Reno health insurance summary may list a specialist visit as $50. This means that each time you receive this service, you pay that flat dollar amount and the insurance company will pay the rest. Other benefits may state CYD and then a percentage after which is coinsurance. It means that you must satisfy your deductible amount first and then you will share the remaining amount of the bill for the percentage listed. Although, coinsurance is usually for more expensive services depending on the type of policy you purchase.

If you have questions about your specific policy or insurance in general, then please call our office for assistance. As your health insurance broker, we do not charge you any fees and can provide you with a no cost in person consultation.