Health Insurance Class - Lesson #16 - Embedded & Aggregate Deductibles

Health care policies refer to individual deductibles as embedded and non-embedded (also known as aggregate or contract deductibles) in family coverage. Your High Deductible Health Plan (HDHP) will require you to meet an annual deductible, which is the total out-of-pocket expenses you pay for covered services before the insurance company pays for covered expenses. Your insurance company will base your annual deductible on your coverage category, such as individual or family. The design of the health care plan will dictate how that certain deductible will be met. Usually this topic is not discussed in general healthcare conversation, but it actually embedded in the plan itself. That is why it is essential to read and understand the plan's Summary Plan Description (SPD) to actually know what benefits the plan has.

[randomeverything]

I am confused to select between hdhp 1500 and 2800. I am in my 30s and healthy.

[bikaladh]

Does this embedded plan apply to Out of Pocket maximum too? Or This applies only for the deductible? I am on PPO plan with 1000 individual and 2000 family. Co-insurance is 80% provider and 20% member. Out of pocket maximum for an individual is 3000 and for a family is 6000. If only one person in my family goes to the doctor throughout the year, What would be the deductible and Maximum out of pocket?