If I have a PPO health insurance policy with a $2500 deduct. once that is paid...i'm good to go?

Question

Meaning if everything on my schedule of benefits says "deductible plus 0% coinsurance" does that mean I pay the $2500 and covered for the year? (single plan) I also have a health spending account which the company matches. What if this is my husbands insurance...i have no insurance and i get pregnant...will it cover my maternity based on this info i've provided?

Answer 1

If I'm reading this correctly you are not on the policy? If that is your husband's insurance and you are not on the policy you will have no coverage for anything. However, the HSA account can be used for all of your medical charges. If you are on the policy the deductible may be per person or per family. If per person you each have a deductible of $2500; if per family you both contribute to the $2500. In either case, once the deductible is met there is no additional charges for covered procedures.

Answer 2

If you have a 2500 deductible and O coinsurance then yes once you run a bill of 2500 and you pay that bill then yes you are covered for the year, if those charges are included in your schedule of benefits on your policy. If you did not purchase a "Maternity Rider" then you do not have "Maternity Insurnance" be very careful companies are very fickle when it comes to Maternity Insurance.

If you have any more questions email me I am an Insurance Broker.

Answer 3

The deductible refers to the amount of money that the insured would need to pay before any benefits from the health insurance policy can be used. This is usually a yearly amount so when the policy starts again, usually after a year, the deductible would be in effect again. Some services, like doctor visits, may be available without meeting the deductible first. Usually there are separate individual deductible amounts and total family deductible amounts.

Since you have 0% co-insurance after $2500 you should be good after that.  Coinsurance or copayment would be the amount that would need to be paid by the insured before the insurance pays and in addition to the deductible. Some health insurance plans will let the insured use some services with just the coinsurance payment, like visiting the doctor, even before the deductible is met.

Your policy may have "max out of pocket" listed somewhere as well, which is the cost one would pay out of their own pocket. An out of pocket expense can refer to how much the co-payment, coinsurance, or deductible is. Also, when the term annual out-of-pocket maximum is used, that is referring to how much the insured would have to pay for the whole year out of their pocket, excluding premiums.

Good luck!

Answer 4

Employer sponsored health insurance without maternity coverage went away years ago.  It would be covered.  Coventry is a legit company.