business, insurance

What is a Health Medical Plan Deductible?

The most common services that this applies to are office visits, generic drugs and preventative care.

An Example of How the Annual Deductible Works:

If your annual deductible is $1,000, you would be responsible for paying for $1,000 worth of health care expenses (excluding co-pays as mentioned above) for the year. After you have paid that $1,000 the insurance company would contribute to your costs as outlined by your policy. With most PPO plans, this usually means that you will be responsible for a percentage of the fee negotiated by the insurance company with the service provider and the insurance company will pay the balance. Note that most policies include a capped annual out of pocket maximum.

There are two basic types of annual deductibles, individual and family. Individual deductibles apply separately to each covered person. With an individual deductible, each member must meet the annual deductible before the insurance company contributes to the costs of that individual.

Family deductibles apply to all covered members of a family. Depending on the guidelines, meeting the deductible can be shared by two or more family members.

This leads us to one of the most common family deductible formats, the two member max.

The Two Member Max Clause:

If you have a policy that covers more than one person, your policy may have a footnote on the annual deductible that says “2 member max”. This means that two of the people covered on the policy must each meet the deductible before the insurance company will help pay for your health care costs.

If just one person meets the deductible, the insurance company will contribute to that person’s health care costs. Note that this person’s future expenses do not count towards any other member’s deductible. The second person must meet their own deductible before the insurance company will contribute to their health care expenses.

If there are more than two people covered under the policy, once two of the members have reached the deductible, the insurance company will contribute to all members’ health care costs.

Don’t let your annual deductible take you by surprise. Know what it is and how it is structured.

Across the nation, employers are either spending a lot more to cover employees with health insurance or dropping that as a company benefit completely. According to the nonprofit Commonwealth Fund, the average cost of providing employees with family coverage has reached a national average of $13,027. Yet, in more than half of the states (27, in fact), the average state-wide cost was even higher.

Between 2003 and 2009, the average cost of family health insurance policies rose by a whopping 45 percent in Pennsylvania and by 50 percent in Maryland. The worst hit was Louisiana with a 59-percent hike.

Almost a third of the people in the U.S. without health insurance work for companies with fewer than 100 employees, according to a March 2008 population survey. Another 2008 survey by the Kaiser Family Foundation found that while large companies have continued to provide health insurance at relatively unchanged levels, the percentage of small companies doing so fell to just 59 percent.

Small Business Owners Lose When They Stop Covering Employees

Small businesses can be harmed in several ways when they drop coverage for employees.