What are out-of
pocket costs?
Even though major medical plans provide broad coverage, insureds still incur certain
costs. They include the deductible, cost-sharing amounts arising from the operation of the
coinsurance clause, and medical expenditures that are deemed by the plan to be in excess
of "reasonable and customary" charges. Only charges that are "reasonable
and customary" for a specific type of service, in a particular location or geographic
area, are eligible for reimbursement under medical expense plans. The definition of
"reasonable and customary" may vary somewhat from one medical expense plan to
another.
