The deductible is the amount that members must pay before post-deductible benefits kick in.
Post-deductible benefits are when members only pay a copayment or coinsurance for covered services.
Family plans have both individual deductibles, which apply to each person, and a family deductible, which applies to all family members.
Under a family plan, post-deductible benefits kick in for an individual once that person meets their individual deductible or the family meets the family deductible. This means that a member on a family plan that's met the family deductible can enjoy post-deductible benefits even if that member hasn't met their individual deductible.
Example 1: Family Deductible Not Met
Consider a plan with a $4,000 individual deductible and an $8,000 family deductible. If one member of the family meets the $4,000 individual deductible, and no other members of the family seek care, the $8,000 family deductible doesn't matter for that individual. Post-deductible benefits kick in for that family member.
Example 2: Family Deductible Met
Consider this same plan. If several family members have each paid toward their individual deductibles, and the individual amounts add up to at least $8,000, then the family deductible is met and post-deductible benefits kick in for all family members, even those who haven’t reached their individual deductibles.
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