Which term describes the specific sum a health insurance plan requires to be paid before any benefits are applied in a calendar year?

The term that accurately describes the specific sum a health insurance plan requires to be paid before any benefits are applied within a calendar year is known as the calendar year deductible. This amount represents what the policyholder must spend on covered healthcare services before the insurance policy begins to contribute to the costs.

Once the deductible is met, the insurance provider will then start to pay for a portion of the medical expenses, according to the terms laid out in the policy. Understanding the concept of a calendar year deductible is essential for policyholders to effectively manage their healthcare expenses and to plan for out-of-pocket costs throughout the year.

In contrast, co-payments refer to the fixed amount that a policyholder pays for specific services or medications at the time of service, and are incurred after the deductible is met. The out-of-pocket maximum is the upper limit on what a policyholder will have to pay for covered healthcare in a policy year, which includes the deductible, co-payments, and coinsurance. Finally, a premium is the amount paid regularly (monthly, quarterly, or annually) to maintain the insurance policy itself, rather than being tied to the costs of actual healthcare services.