by clallen » Wed Oct 13, 2010 11:39 pm
I pay 136.45 every 2 weeks for major medical, with a $10.00 co-pay, right now. The first thing is the deductible, it went up from 100/200 to 500/1500. What is a dedutible anyway, and how does this affect my pay?
Posted: Thu Oct 14, 2010 05:16 am Post Subject:
Although some of your question is missing (because it was typed in the subject line), it appears that your employer is changing health insurance companies.
A deductible is the amount of claims that are your responsibility before the insurance company begins to pay claims. When your deductible is described as "500/1500", it means that the deductible for one person is $500, and the deductible for the rest of the family (aka: family deductible) is another $1000 (effectively, 3x the deductible for one insured).
What is not known is the language that describes how the "family deductible" is determined. It is not uncommon for the policy to state something like: "One insured must satisfy his individual deductible before all other deductible amounts may be aggregated to satisfy the family deductible." Although unfavorable to insureds, a contract could just as easily read: "Each individual insured must satisfy their individual deductible."
In addition to deductibles, you also need to be aware of the out-of-pocket limit -- your total out of pocket cost (which may or may not include the deductible). It does not include premiums. Some policies do not count copays toward the out of pocket limit, others do. You'll have to read the contract or outline of coverage to know for sure.
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