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What are health insurance deductibles

A deductible is the amount of money someone has to pay out of pocket for medical expenses before health insurance kicks in and begins covering the expenses.

For example, an employee is covered by a $2000 deductible plan and incurs $1750 in medical expenses this year. The insurance carrier will not cover any of that amount, with the exception of any services that explicitly waive the deductible.

Employees can view their insurance deductibles from their Medical, Dental, or Vision Overview pages. The plans deductible will be visible under the Benefits Summary section.

Once the deductible is met, enrollees are still responsible for paying coinsurance or copays up to a maximum amount (out-of-pocket max) specified by their plan. Keep in mind that not all plans and services require copays, so check the Summary of Benefits and Coverage for more information.

If a health insurance plan has an embedded deductible, a single member of a family enrolled in family coverage does not have to meet the full family deductible in order for the after-deductible benefits to kick in.

Instead, the person's after-deductible benefits can start as soon as the individual has met the individual deductible, even if the coverage is obtained through a family plan.

Deductibles reset each year, either on calendar year or on the plan year cycle. View the plan's Summary of Benefits and Coverage to confirm when the deductible resets, or reach out to your insurance broker if the Summary doesn't mention the reset cycle.




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