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.
Embedded Deductible
Non-Embedded Deductible
Coinsurance begins:
- If any individual on a family plan meets his/her individual 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 individual 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 insurance carrier for all family members.
Coinsurance begins:
- If one or more family members combine to meet the family deductible of $3,000 coinsurance begins for all family members.
- If one or more family members combine to meet the family out-of-pocket maximum of $4,500, all eligible costs thereafter are covered 100% by the insurance carrier for all family members.
Medical Insurance Terms
What comes out of my pay?
Annual premium
The annual cost to purchase medical coverage is spread across the year, so you pay a portion of it in each pay period on a pretax basis. Medical premiums are based on the plan you choose and the number of people you cover.
What will I pay after I meet my deductible?
Coinsurance
After you meet the annual deductible, generally, you’ll continue to pay the stated coinsurance percentage for in-network covered medical services until you meet the out-of-pocket maximum. The plan pays the rest.
What will I pay when my medical coverage starts?
Annual deductible
You won’t pay for in-network preventive care defined by the U.S. Preventive Services Task Force, such as your annual checkup. Generally, for all other covered care, you’ll pay the amount of your annual deductible before the plan starts to pay.
How much will I pay out of my own pocket?
Out-of-pocket maximum
This is the most you would pay for covered medical services in a calendar year. Once you meet it, the plan pays the full cost of additional covered care.
Will my doctor be in-network?
Provider network
You can confirm whether your doctor is in-network by going to the carrier website, selecthealth.org. Make sure to click on the Select Med network.
What is Capstone Nutrition contributing?
Company contribution
Capstone Nutrition pays a portion of your monthly premium to limit your monthly cost and provide you with affordable coverage options.
