Annual Deductible

This is the annual amount of covered healthcare expenses for which you are responsible before the insurance begins paying. Often, prescription drug copayments are not applied toward this deductible amount.

Individual deductibles are satisfied when one covered person has paid the deductible amount. Then the insurance plan will begin to pay claims for that person. The family deductible amount is often two or three times the individual deductible. The family deductible is satisfied for all family members when two or more family members have paid an amount toward the deductible equal to the family deductible. At that time, the plan will pay for covered services for all family members according to the plan’s coinsurance benefits.

Some plans do not have a family deductible, but have a two-member maximum. Insurance benefits begin to pay for services for each family member only after such member has satisfied the individual deductible. In the event that two family members reach the individual deductible, then all family members are considered to have satisfied the deductible. Family members that have paid toward the deductible, but did not reach it, may have such monies reimbursed by the insurance company.

Aggregate deductibles are typically associated with HSA-eligible plans. Family plans with aggregate deductibles do not have an individual (or per-person) deductible and do not begin to pay for covered services until the combined payments from family members satisfy the aggregate deductible.