Posted: Wed Aug 27, 2008 9:12 am Post subject: Co-insurance and deductible?
I was wondering whether Co-insurance comes after the deductible or is it includes the whole insurance claim..Say I have a deductible of 500$ and a 70/30 coinsurance policy .When does the coinsurance come into play?After I pay the 500$ deductible or for the whole sum of the insurance claim?
The deductible comes off of your part if it's 70% then the deductible comes off that...(on all co-insurance claims I've worked anyway). _________________ Have you been helped by a poster? Do you want to show your appreciation? YOU CAN !! Just simply click on the donate button and send them some coin!
Hi dear..suppose you have a claim amount worth $ X with a deductible worth $500 & a Co-insurance of 70/30, over here you're all set to pay {(500 + 30% of (X-500)}.
I say this because co-insurance is calculated as the % of allowed expenses once the deductible is paid up. Fatman
I agree with what Fatman has said. Deductible needs to be paid before the insurance benefits kick in. Its your must pay 'out-of-pocket' share and is determined in dollar terms.
Suppose, your insurer has promised to cover 80% of the medical expenses after you pay the deductibles. Hence, you should pay the deductible amount along with the remaining 20% of the costs.
Normally, the co-insurance is expressed as a percentage of the covered expenses.
So what is the use of deductible then ?If there is an agreement of sharing in co-insurance is it really necessary to have deductibles also in your policy?
The deductible must be met before the insurer will pay anything. Covered expenses in excess of the deductible, in your case, will be paid @ the 70/30 co-insurance rate, up to any "stop-loss" limit that may apply in your policy.
To answer this question:
Quote:
So what is the use of deductible then ?If there is an agreement of sharing in co-insurance is it really necessary to have deductibles also in your policy?
It's impossible to find a major-medical insurance plan that does not contain a deductible, and has been so for decades. HMOs generally have no deductible, they have "co-pays." PPO plans will commonly have deductibles which will vary with the plan. The purpose of a deductible in medical expense coverage is no different than those found in car insurance. They are primarily intended to eliminate small claims, and force the insured to retain part of the cost of the loss. You may be able to change the amount of the deductible, depending on whether it's a group or inidvidual plan. Just remember, the lower the deductible, the higher the premium costs will be.
With many plans, the deductible is waived for certain services, but applied to others. Hope this helps in some way...
The purpose of the deductible is to reduce the costs the insurer has to pay.
It keeps people from over using their policies. It also shifts the smaller expenses to the insured and this means that the insurance company doesn't have to pay administrative people to handle the claims for the small stuff.
