Deductibles, Co-Pay and Out of Pocket Maximums

How Do Deductibles Work?

When you purchase a global medical health plan, you may have the option of choosing a deductible amount. We are often asked: How do deductibles work? If, for example, you choose a deductible of $250, you’ll need to pay the first $250 of a covered claim(s) in any period of cover directly to your hospital, clinic or doctor at the time of treatment. So if your treatment costs are $500, you’ll need to pay $250, and your provider will pay the remaining $250 of covered costs. If a deductible is chosen, you would only have to pay this once during any period of cover regardless of the number of claims.

What Is Cost Share and Out of Pocket (OOP) Maximum?

Cost share (also known as the co-insurance or co-pay) is the percentage of every claim you will pay. Out of pocket maximum is the maximum amount you would have to pay in cost share per policy period. An Example :

  • You have a claim value of $20,000
  • You have a $500 deductible on your policy
  • You have a 20% cost share with a $5,000 out of pocket maximum

You would pay $4,400 and the insurance plan would pay $15,600. Typically, once the deductible and co-pay/cost share is met, the insurance plan covers 100% of all future costs. Here is an infographic that illustrates the examples above.

Deductibles and Cost Share Infographic