Let us take an example: The medical bill is $25,000; Deductible is $100 and choosen Policy Maximum is $50,000.
- Insurance coverage is $50,000
- Deductible is $100 per certificate period
- Coinsurance for claims incurred Out of Network: After the deductible, 80% of first $5,000 and then 100% to the policy limit
- 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 $50,000. and the total amount billed is $25,000, the policy will pay 80% of first $5,000 then 100% up to the policy limit ($50,000). 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