Understanding your deductible

Your deductible is the amount you must pay for covered services before your insurance plan begins to pay for covered services. For example, if your plan has a $2,000 individual deductible, you’ll pay the first $2,000 for covered services. You can meet the deductible with an all-at-once charge for an expensive service — such as an MRI or surgery — or with charges from several small services — such as doctor visits — where you pay a small copay. Keep in mind that copays don’t usually count toward your deductible.

Embedded Deductible

An embedded deductible is where each family member has an individual deductible in addition to the overall family deductible. When a family member meets their individual deductible before the family deductible is reached, the insurance company will begin paying according to the plan’s coverage for that member. If only one family member meets an individual deductible, the rest of the family still has to pay their deductibles until the family deductible is met.

Non-embedded Deductible

A non-embedded deductible is more straightforward than an embedded deductible. With a non-embedded deductible, there is only a family deductible. All family members’ out-of-pocket expenses count toward the family deductible until it is met, and then they are all covered with the health plan’s usual copays or coinsurance. It doesn’t matter if one person incurs all the expenses that meet the deductible or if two or more family members contribute toward meeting the family deductible. The non-embedded deductible is most common in high deductible health plans.

Coinsurance

Once you’ve met your deductible, you’ll pay coinsurance for covered services. Coinsurance is the percentage of costs you’re responsible for paying, which counts towards your out-of-pocket maximum.

Premiums

Premiums are deducted over the course of 24 pay periods and are used to pay for your benefits — think of this like paying for a gym membership — you pay a fee to use the equipment. For insurance, you’re paying a membership fee for discounted services and access to specific providers.

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. Make sure to choose the Preferred ValueCare or FocalPoint.

What is Henriksen Butler contributing?

Company contribution
Henriksen Butler pays a portion of your monthly premium to limit your monthly cost and provide you with affordable coverage options.