Coinsurance

The percentage of an eligible claim the plan reimburses.

Coinsurance is the share of an eligible expense your plan pays — expressed as a percentage, with the employee covering the remainder. A dental plan at 80% coinsurance reimburses eight dollars of every ten spent on covered basic services.

It is the single most-adjusted lever in plan design because it moves cost without removing a benefit. Dropping drug coinsurance from 100% to 90% reduces premium while leaving the drug plan fully in place.

What this means for a BC plan

In BC plans we review, drug coinsurance below 80% tends to generate employee complaints, particularly where PharmaCare deductibles already leave a gap. Dental coinsurance has more room to move before anyone notices.

Related terms

  • Deductible — The amount an employee pays before the plan begins reimbursing.
  • Annual maximum — The ceiling a plan will pay for a benefit in one plan year.
  • Dispensing fee cap — A limit on the pharmacy fee the plan will reimburse.

Where this comes up

What a group plan includes · All glossary terms · Ask an advisor directly

General information only, not advice for your specific plan. See our legal and licensing disclosures.