Embedded vs Aggregate Deductibles
It’s important to understand how deductibles work when determining what health plan works best for you. The majority of the health plans we offer have embedded deductibles with the exception of the HDHP with HSA plan.
Embedded deductible- If you have family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all the family members meets the overall family deductible.
Example: In our $1,000 PPO plans there is a family deductible of $2,000. During the course of the plan year, your spouse experiences an injury with medical expenses of $1,500, he/she would have met his/her individual deductible, and he or she would have their medical expenses covered at 90% coinsurance for the rest of the year. But you and your child would still need to meet the remainder of the deductible until the family deductible is met. Suppose that, later on in the year, you and your child have collected $500 of medical expenses together. Therefore, you would fulfill the family deductible limit of $2,000. From this point onward during the plan year, you would no longer need to pay any deductibles, and the plan would begin to pay covered medical expenses for the entire family at 90%.
Aggregate deductible –If you have family members on the policy, the total family deductible must be met before the plan begins to pay. This can be done by one person or a combination of more than one family member.
Example: In our HDHP there is a family deductible of $5,000. During the course of the plan year, say your family has spent $4,000 on medical expenses in total, with $3,800 of that amount attributed to an injury you sustained. At this point, the insurance would not pay the 90% co-insurance (the after-deductible benefits from the plan) because the family deductible of $5,000 has not been met.