Deductibles 101
Posted on June 22, 2011
Many HNE plans are offered with deductibles. A deductible is a way for you to share in the cost of the health care you receive. A deductible is an out-of-pocket expense that you pay to a provider for certain medical services prior to the insurance payment. Insurance plans with HNE can vary, so it is important to review the Explanation of Coverage (EOB) for the specific benefit packages offered by your employer. This will ensure that you know what out-of-pocket expenses you may incur in the policy year.
There are some exclusions to what applies to your deductible, based on the plan type. The federal health care reform bill mandates that health screenings and preventive services be covered without copays or other fees.* These benefits are usually offered once per calendar or benefit year, based on your specific benefit.
You can meet the deductible by paying many small claims, for example, office visits, lab test, or radiology, or by applying larger claims to a deductible, for example, hospital stays, outpatient surgery, or MRI services. Once you meet your deductible, claims will be paid by HNE and will apply to any applicable copays or coinsurance.
Your use of medical services throughout the year might be minimal. In that case, the out-of-pocket cost towards your deductible is low, if any. You don’t need to meet the deductible, but if you do, your responsibility switches to only copays and applicable coinsurance.
If an employer offers you different plan options, it is important for you to make an educated decision based on your health expectations. For example, if you expect your medical use throughout the upcoming year to remain low, you might choose a policy with a higher deductible that will have a lower monthly premium. A lower deductible plan will likely carry a higher monthly premium; in that case HNE would start paying claims sooner.
* This requirement will apply only to new plans, not to existing plans that are grandfathered under the new law. Federal regulators determine what is a grandfathered plan.
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