Health Insurance Deductible: Family Deductible

HBI Blog / Health Insurance Deductible: Family Deductible
Family Deductible

Family Deductible… although sounds very simple, but it ain’t, for certain. Let’s dive deeper. Simply put, it is designed to help families with their total annual health insurance deductible. We wrote a detailed article on what is individual health insurance deductible.

What is Family Deductible?

Most family health insurance policies come with a deductible amount and an individual deductible amount. Whenever a family member makes a payment towards the personal deductible amount, the same is credited towards the family deductible.

Individual coverage begins as soon as a family member meets their deductible. For a family, post-deductible coverage commences once the family deductible is met.

Confused? We get it

Let’s try to simplify this with the following examples.

For this, we consider a family of four (dad, mom, and two kids) with an individual deductible of $4,000 and a family deductible of $10,000.

In February, 2022

  • Mom pays $4,000 in deductible for a surgery.
  • Mom has now met her deductible.
  • The family deductible is credited with $4,000, still $6,000 away from reaching the target amount for the year.
  • Mom starts to receive post-deductible benefits.
  • Dad and the children are yet to receive any post-deductible benefits.

In March, 2022

  • Johnny (1st child) sees a surgeon and the parents pay $2,000 out of pocket, which goes towards unmet deductible costs.
  • Timmy (2nd child) sees a doctor and the parents pay $1,000 out of pocket, which goes towards unmet deductible costs.
  • Family deductible at this point stands at $7,000, with $3,000 still to go.
  • At this point, Mom alone continues enjoying post-deductible benefits.

In April, 2022

  • Dad gets an MRI and pays $3,000 out of pocket, which fulfills the remaining deductible requirement.
  • Now, the family deductible is met ($4,000 for mom + $2,000 for Johnny (1st child) + $1,000 for Timmy (2nd child) + $3,000 for dad = $10,000).

Even though the individual deductible was not met for three members of the family, the health insurer lets the family enjoy post-deductible benefits, as the family deductible has met.

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