Family Deductibles

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.

If you have any questions please feel free to call us at (833) 726-2123 or send an email to hello@sanabenefits.com.