What’s the difference between an embedded and a non-embedded deductible?
With an embedded deductible, the insurance carrier will begin paying for services for any covered member who meets the individual deductible. With a non-embedded deductible, the entire family deductible must be met before the carrier will begin paying.
Here’s how deductibles and maximums for employees with family coverage compare across plans.
Traditional Copay Plan
(Embedded)
(Embedded)
High Deductible Health Plan
(Non-embedded)
(Non-embedded)
Annual deductible/coinsurance
- If any individual on a family plan meets his/her deductible of $1,000, coinsurance begins for that individual only.
- If one or more family members combine to meet the family deductible of $2,000, coinsurance begins for all family members
- If any individual on a family plan meets his/her out-of-pocket maximum of $3,000, all eligible costs thereafter are covered 100% by the insurance carrier for that individual only.
- If one or more family members combine to meet the family out-of-pocket maximum of $6,000, all eligible costs thereafter are covered 100% by the insurnace carrier for all family members.
Annual deductible/coinsurance
Coinsurance begins:
Coinsurance begins:
- If one or more family members combine to meet the family deductible of $4,000, coinsurance begins for all family members.
- If one or more family members combine to meet the family out-of-pocket maximum of $8,000, all eligible costs thereafter are covered 100% by the insurance carrier for all family members.
