$\backslash$table$[[$Terms$,$Definitions$],[$EOB: $,\backslash$table$[[1.$ A portion of the medical cost you pay after your deductible has$],[$been met. You and your insurance carrier each pay a share of eligible$],[$costs that add up to $100$ percent.$],[2.$ The most you could pay for covered medical expenses in a year.$],[3.$ The amount paid out of pocket by the policyholder before an$],[$insurance provider will pay any expenses.$],[4.$ The monthly payment to be covered by a health plan.$],[5.$ Explanation of benefits$],[6.$ A flat fee that you pay on the spot each time you go to your doctor$],[$or fill a prescription.$]]],[$Enter Number$],[],[$Enter Number$],[],[$Copay:$],[$Enter Number$],[],[$Coinsurance:$,\backslash$table$[[7.$ The doctor joins your insurance company's network of health$],[$careproviders and agrees to charge less so you pay less.$]]],[$Enter Number$],[\backslash$table$[[$Out$-$of$-$pocket$],[$maximum:$]]],[$Enter Number$],[$Premium:$,$t$],[$Enter Number$],[$In$-$Network prov$],[$Enter Number$]]$