Carnegie Mellon University

Insurance Literacy

Understanding an insurance plan can be confusing, so it is important to understand your plan’s benefits and coverage. To understand the SHIP, we recommend you review the plan’s Summary of Benefits and Coverage.

Being familiar with the following terms will also be helpful: 

In-Network and Out-of-Network

  • In-Network providers (doctors) or facilities (laboratories, urgent care centers, hospitals, or imaging centers) participate in your insurance plan network. The most cost effective way to seek care is to see healthcare providers that are in-network. If you have the CMU SHIP and see an in-network provider, there is no deductible.
  • Out-of-Network providers do not participate in your insurance plan network. If you have the CMU medical SHIP and see an out-of-network provider, the plan will cover 80% of the cost of the service after you meet your deductible. The dental plan has different coinsurance rates.


Copays are a one-time payment at the time of service and can range depending on the service being provided. For the CMU SHIP, most copays are $0-$25. Some services have a higher copay, such as advanced imaging ($40), emergency room visits ($125), and hospital admissions ($150). You must pay the copay once for each visit where it is applicable. Prescriptions also incur a copay, but copays depend on the type of medication and frequency of refill. 



A deductible is the amount of money you pay for health care services before your insurance plan starts to pay covered expenses. It is important to review insurance plans so you are aware if there is a deductible or not. Once the deductible is met, the plan will start covering benefits as outlined in the policy.

The CMU medical SHIP has no deductible for in-network care, but there is a deductible for out-of-network care. The dental SHIP has a deductible for both in-network and out-of-network care.


Coinsurance is a portion of healthcare charges that the member is responsible to pay, usually after a deductible has been met. There is no coinsurance for in-network care with the CMU medical SHIP. For out-of-network care with the CMU SHIP, you would be responsible for 20% of covered charges, after paying the deductible amount. Coinsurance rates vary depending on the plan and the service, so you must review plan(s) carefully. 

Explanation of Benefits (EOB)

EOBs show the total charges for your visit and which portion of charges the health insurance plan will cover. EOBs are not bills. EOBs help you understand how much your health plan covers, and what you can expect to pay when you get a bill from your provider.