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My friend is working for a company in the US (CA). She works for an international company that happens to use a Japanese insurance provider and she’s trying to decide what level plan to sign up for.

The part that has us scratching our heads is their really strange coinsurnace structure. There are many fields which are listed as “100% coinsurance.” After looking at many handfuls of websites for the definition of coinsurance, it’s pretty clear that the 100% refers to the amount she will have to pay for the relevant services. That would all make sense, if it wasn’t for the fact that all these 100% coinsurnace items are found for the “in network” column and all their corresponding out of network fees are lower (70-80%)!

Could they be using a different definition for coinsurnace, one where the % refers to the amount covered by the insurance. As perhaps that’s the standard in Japan or elsewhere?

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    ask the provider? – user253751 Mar 5 at 12:23
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    are there any examples they provide? – mhoran_psprep Mar 5 at 13:31
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    What are the deductibles in both cases? It may be that you pay 100% up to the deductible in-network and only 70-80% out-of-network, but with a much higher (or no) deductible. – D Stanley Mar 5 at 13:54
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    Sorry if this sounds obtuse (considering you took the time to ask the question here), but it seems like the easiest way to answer this would have been for your friend to ask the benefits coordinator at her HR department (or the insurance plan directly), versus talking to you, and you asking us. We really have no way to give you a meaningful answer. What if we say "yeah, sometimes the meaning is backwards" or "no, it really means 100%" and we're wrong? Wouldn't your friend be better off actually asking the people who know how the plan works, and/or the people who will be processing her claims? – dwizum Mar 5 at 14:00
  • Are the services that are listed as 100% preventative (physicals, etc) or not (hospital, sick visits, etc). – TTT Mar 5 at 16:21
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I seriously doubt that the health insurance would offer to pay more for out of network providers, although I have no experience with Japanese health insurance. But if it is a Japanese company providing a plan for US employees, I would assume that it would roughly match the conventional plans in the US.

This is most likely a confusion of terms/translation and is meant the opposite of the conventional way. In other words, the coinsurance percent refers to the amount that insurance pays. So your friend would effectively pay 0% for in-network and 20%-30% for out of network.

In the end your friend should contact the insurance provider and clarify. Insurance documents are notoriously hard to understand sometimes so for all we know the above might not even be the correct interpretation.

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