Let us take an example: The medical bill is $25,000, Deductible is $100 and choosen Policy Maximum is $300,000
- Insurance coverage is $300,000
- Deductible is $100 per certificate period
- Co-Insurance : Out of PPO network if within U.S. - 80% of the first $5,000 of the eligible charges, then 100%.
- Total medical expenses is $25,000
The insured must pay the deductible ($100) before the insurance plan pays anything. Since the policy maximum coverage is $300,000 and the total amount billed is $25,000, the policy will pay 80% of first $5,000 then 100% up to the policy limit ($300,000). In this case the insured expense after the deductible is 20% of first $5,000, which is $1,000. Thus your final expense is $1,000 while the insurance company will cover the remaining $24,000.