What is the coinsurance clause in health insurance?

The coinsurance clause in health insurance is a provision that requires the insured to share a specified percentage of the costs of covered services. This means that after the insured has met their deductible, they are responsible for paying a certain percentage of the remaining costs for healthcare services received, while the insurance company pays the rest. For example, if a policy has an 80/20 coinsurance clause, the insurer pays 80% of the costs, and the insured pays 20%. This structure helps to reduce overall healthcare costs by encouraging insured individuals to be more mindful of their healthcare spending since they will share in the costs.

The other options describe different aspects of health insurance but do not accurately define coinsurance. A flat fee for every visit relates to copayments, not coinsurance. Prohibiting coverage for certain treatments pertains to exclusions and limitations within policies. A limit on claims pertains to the policy's limitations on the number of claims that can be made rather than the shared financial responsibility for costs, which is the essence of the coinsurance concept.