DEDUCTIBLES

Hospital Certification Noncompliance Deductible

If the Hospital Certification Program procedures explained above are not followed when a person is hospitalized, a $250 deductible will apply to the covered medical expenses incurred for each such hospitalization in addition to the calendar year deductible. If the Hospital Certification Program procedures are followed, this deductible won't apply.

Calendar Year Deductibles

Individual Deductible - The individual deductible is the first $300 of covered medical expenses incurred by a family member during a year. You must pay this $300 of expenses out of your own pocket. Once a family member has incurred $300 of covered medical expenses during the year, he has satisfied his deductible.

Family Deductible - After two or more persons in your family have incurred a total of $600 in covered medical expenses applied toward calendar year deductibles in a year, the family deductible has been satisfied. No further individual deductibles will be required of your family for covered medical expenses incurred during the rest of that year.

Calendar Year Deductible Rules

  1. All deductibles are based on an accumulation period of a calendar year, and only covered medical expenses can be used to satisfy deductibles.
  2. If a person is suffering from a condition for which covered medical expenses are incurred in two or more years, the deductible must be satisfied each year.
  3. Each family member must satisfy the individual deductible each year with the following exceptions:
    • Once the family deductible is satisfied during a year, no further individual deductibles must be satisfied by any other family members during that year.
    • If two or more family members are injured in the same accident, only one deductible is applied each calendar year for all expenses resulting from that accident.
    • If any part of a person’s individual deductible is applied to covered medical expenses incurred during October, November, or December of a calendar year, that person’s individual deductible for the following year will be reduced by the amount applied.

You, the employee or retiree, are responsible for paying expenses used to satisfy deductibles for yourself and your dependents.

Emergency Room Deductible

A $50 deductible applies to each occurrence of hospital emergency room treatment, whether the treatment is for an accident or illness, whether the hospital is a PPO or non-PPO hospital, and whether or not the emergency room visit results in an inpatient admission. Emergency room deductibles are in addition to the regular calendar year deductible and do not apply to the out-of-pocket maximums.