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Coinsurance
(redirected from coinsurance clause)

   Also found in: Dictionary/thesaurus, Medical, Legal, Wikipedia 0.07 sec.

Coinsurance. When your healthcare insurance has a coinsurance provision, you and your insurer divide the responsibility for paying doctor and hospital bills by splitting the costs on a percentage basis.

With an 80/20 coinsurance split, for example, your insurer would pay 80%, or $80 of a covered $100 medical bill, and you would pay 20%, or $20.

Some policies set a cap on your out-of-pocket expenses, so that the insurance company covers 95% to 100% of the cost once you have paid the specified amount.

Coinsurance may also apply when you buy insurance on your home or other real estate. In that case, insurers may require you to insure at least a minimum percentage of your property's value -- usually about 80% -- and may reduce what they will cover if you file a claim but have failed to meet the coinsurance requirement.

Coinsurance also describes a situation in which two insurers split the risk of providing coverage, often in cases when the dollar amount of the potential claims is larger than a single insurer is willing to handle. This type of coinsurance is also called reinsurance.



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Your policy has a $500 deductible with an 80/20 coinsurance clause with a maximum out of pocket $2000.
Absent the agreed value provision, if, at the time of loss, it is determined that the amount of insurance is less than the limit required by the coinsurance clause for all locations, the insured is penalized or considered to be coinsured (partners with the insurer).
Until recently, there was either no coinsurance clause or a significantly smaller coinsurance clause.
 
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