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Related to Coinsurance: Coinsurance effect


A provision of an insurance policy that provides that the insurance company and the insured will apportion between them any loss covered by the policy according to a fixed percentage of the value for which the property, or the person, is insured.

Insurance is intended to spread the risk of any loss among every insured who purchases a particular type of policy from an insurance company and the company itself. The likelihood that every policyholder will suffer the loss that has been insured against is slim, and, therefore, an insurance company should be able to compensate those who have losses, if those policyholders have complied with the terms of their policies.

Coinsurance divides the risk of loss according to the amount of insurance purchased by each person through the payment of premiums. The size of insurance premiums is based primarily upon the value of the property covered by the policy. If a person fails to insure a property for an amount close to its actual cash value or replacement cost, then the person must accept a greater share of the risk of loss than someone who pays larger premiums to insure his or her property for an amount close or equal to its actual value.

In insurance policies for fire or water damage the coinsurance clause provides that property must be insured for a specific percentage, usually 80 percent of its actual cash value. The 80 percent provision is known as the New York Standard Coinsurance Clause. The owner of the property is liable for the remaining 20 percent of its actual cash value. If the insured party's property is only partially damaged, that person's recovery under the policy will be reduced in proportion to the amount of loss suffered.

For example, a homeowner has a $120,000 fire insurance policy on her home, which is valued at $150,000. The woman's coverage is 80 percent of the home's actual cash value. If her house is completely destroyed by a fire that is not Arson, she will recover $120,000, which is the full face amount of the policy. She is responsible for the remaining 20 percent of its actual cash value, or $30,000. If a fire caused only $20,000 worth of damages, the homeowner could recover only $16,000, or 80 percent of the loss. The homeowner is a coinsurer for the remaining $4,000, or 20 percent of the replacement cost of the property.

If that homeowner has purchased only $36,000 worth of fire insurance, or 60 percent of replacement costs, thereby paying a lower premium than a policy with coverage for $48,000, she would be responsible for a larger share of the damages incurred in the total or partial destruction of the property. The total destruction of the $60,000 house will result in a recovery limited to the amount of insurance bought by the homeowner, or $36,000. She is responsible for 40 percent of replacement costs. The recovery for the partial loss of $20,000 will be $12,000, or 60 percent of the loss, since recovery is reduced proportionately by the amount of actual loss.

Although insurance policies stipulate a specific percentage of loss that must be covered, an insured may purchase maximum insurance coverage for up to 100 percent of the replacement cost of the property covered by the policy. The premiums for such protection will be proportionately larger than the one for 80 percent of the property's actual cash value.

Coinsurance clauses in fire or water damage policies encourage property owners to purchase full or nearly full coverage. It is important for policyholders to periodically review their insurance policies to verify that their coverage adequately protects the value of their property.

In medical or Health Insurance policies, coinsurance has a similar meaning. The amount of expenses that a medical insurer will reimburse a policyholder is a fixed percentage—usually 80 percent—of the approved charges—the amount of a submitted bill which the insurer considers reasonable and will reimburse after the policyholder has paid the deductible, which is usually the first $100 of medical expenses. The insured becomes a coinsurer for the remaining 20 percent of the approved charges as well as for the amount by which the individual medical bills exceed the approved charges.


n. when the insurance company insures only a partial value of the property owned by the insured owner. Essentially the owner and the insurance company share the risk.

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References in periodicals archive ?
A two-part model on the full sample determines average changes in copayment and coinsurance associated with the transition and postparity periods, controlling for covariates, and stratifying by INN-only versus INN/OON (Duan et al.
We estimated that the total lifetime costs for [the Centers for Medicare & Medicaid Services], which included colorectal cancer screening, surveillance, and treatment with coinsurance, to be $2.
But, it is disingenuous for the drug industry to argue that cost-sharing is the problem, when the highest level of cost-sharing is typically the result of coinsurance, and therefore is directly linked to prescription drug prices.
If a coinsurance percentage is shown, in the Declarations, the following condition applies:
Divide the maximum anticipated business income exposure by the coinsurance basis.
The main effect of this option is to substitute a limited coverage period of 120 days for the annualized coinsurance requirement.
If we choose a shallow-loss insurance policy identical to the original SURE policy, but ignoring the disaster component, we would have a coinsurance policy with a shallow-loss coverage threshold at 90% of mean revenue, and with a 60% reimbursement rate.
The co-chairman suggest providing catastrophic protection for seniors by reducing the coinsurance rate to 5% after costs exceed $5,500 and capping total cost sharing at $7,500.
If the patient has seen 4 or more physicians, then the office is to collect 30% of the patient's coinsurance amount for the day's visit after the deductible has been met.
We show that the combination of deductibles and coinsurance can be used to sort rationed policyholders.
Among the basic plan designs are the "Bronze" level, which provides lower monthly premiums but higher outof-pocket expenses in the form of copayments, deductibles and coinsurance, and a "Gold" level with higher premiums but fewer out-of-pocket expenses.
Residents must pay a coinsurance charge on days 21-100 in a SNF Part A stay.