Embedded vs. Non-Embedded Deductible
Non-Embedded
Embedded
When a plan has an embedded deductible, an individual cannot contribute more than that individual deductible amount towards the family deductible. Example: The DHMO Plan has an individual deductible of $500 and a family deductible of $1,000. Once an individual meets the $500 individual deductible, the plan will start paying 90% of the total charges (coinsurance) as that member works towards meeting the individual out-of-pocket maximum of $2,000. The other covered family members would each need to meet their $500 individual deductibles or combined, no more than the $1,000 family deductible, before the plan would start to pay the 90% of their healthcare expenses (coinsurance). Once the $1,000 family deductible has been met, the plan will pay 90% of the charges for all covered members, regardless of who helped meet the family deductible, as they work towards the family out-of-pocket maximum of $4,000.
When a plan has a non-embedded deductible and family coverage is in place (covering one or more dependents), the individual deductible amount does not apply – there is only one family deductible, and any of the covered members can contribute to meeting it.
All four (4) of the medical plan offerings between Kaiser and Cigna offer embedded deductibles and out-of-pocket maximums.
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