Sharing the CostHere’s how the deductible works:
Look it up: The Benefits Summary shows the plan’s deductible, coinsurance and out-of-pocket maximum amounts.See how this works.
|
Plan feature | What LMC Pays (percentage) |
What you pay (percentage) |
What you pay (dollar amount) |
Annual deductible (first $1,000) |
0% | 100% | $1,000 -$250 (Your HealthFund balance) $750 |
HealthFund offsets $250 of annual deductible; you pay remaining $750 to meet deductible. Once deductible is met, you and the plan share remaining cost ($50,000 - $1,000 = $49,000). | |||
Coinsurance (next $12,500) |
80% | 20% | $2,500 |
After the deductible, the plan pays 80% BUT your share is capped by the medical out-of-pocket maximum of-- $2,500. | |||
Claim $$ above employee coinsurance limit (next $36,500) |
100% | 0% | $0 |
Once you reach the medical out-of-pocket maximum, the plan pays covered expenses at 100% for the rest of the calendar year. |
Plan pays: $46,500
HealthFund pays: $250
Your share: (deductible plus coinsurance): $3,250
* Since the HealthFund is not used to pay for prescription drugs, you can use your HealthFund balance toward other medical expenses throughout the year.