A set dollar amount which must be satisfied within a specific time frame before the health plan begins making payments on claims.


Deductibles are primarily applied to surgeries, visits to out of network physicians, lab, x-ray, and hospitalizations. The deductible is a set dollar amount, such as $500, and must be reached and paid for by the patient to the medical providers before the insurance company starts paying on claims. Health plans usually offer a calendar year deductible which means that a patient has 365 days as of January 1st to meet and satisfy their deductible. This amount resets at the beginning of a new year.

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