Aka14212142626

Individual vs. Family Deductible

Discussion created by Aka14212142626 on Jan 8, 2020
Latest reply on Jan 9, 2020 by communitymanager

My health plan has a combined deductible (of $6K) for medical and prescription drug expenses. My family member has an individual deductible of ($3K) on this plan, along with the family deductible; I only see a family deductible on my coverage and benefits page.

 

My summary of benefits states:

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

My questions are, if I am reading the summary of benefits:

  1. Do I have an individual deductible?
  2. My family member must meet their $3K deductible unless the family deductible of $6k has been met.
    1. Secenario A: Wife has met $6K family deductible due to costs from providers. Husband does not need to meet his $3K individual deductible since $6K family deductible has been met. Plan begins to pay since $6K family deductible has been met
    2. Scenario B: Husband meets $2K of family deductible while wife meets $4K of family deductible; plan begins to pay since $6K family deductible has been met.
    3. Scenario C: Husband meets $3K of family deductible while wife meets $3K of family deductible; plan begins to pay since $6K family deductible has been met.

 

Feel free to add any other potential scenarios that I have not thought of.Thanks for the clarification and help!

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