A fixed dollar amount that you must pay out-of-pocket each policy year (calendar year for Klaviyo medical plans) for covered health care services before your plan begins to pay. Depending on the plan you are on there are two different types of deductibles, embedded and non-embedded (also known as aggregate). The deductible resets on January 1 each year.
Klaviyo BCBSMA Medical Plans
PPO and HMO Plan (Embedded Deductible)
The deductible would apply to services such as in-patient hospitalization, outpatient surgery, diagnostic testing, etc. Once you have satisfied your individual deductible, the plan typically pays for these services. Co-pays do not apply to your deductible.
HDHP Saver Plan – HSA Eligible (Non-Embedded Deductible)
The deductible would apply to any service covered under the plan, including prescriptions, except for preventive services. Once you have satisfied your deductible most services will be covered at 100%, and prescription will apply a copay.
If on a plan with covered dependents, each person will be capped at the individual deductible amount. Once a person on the plan reaches their individual deductible level that one person will no longer have deductible responsibility until the deductible resets. At the same time, everyone enrolled on the plan will be working towards the total family deductible cap. Once the family deductible is met, the deductible is considered met for everyone on the plan whether they have met their individual deductible cap.
If covering dependents on the plan, everyone works towards the family deductible cap, and no one person is capped at the individual deductible level. Once the family deductible cap is met, then services will be covered. If on an individual plan, you will only be responsible up to the individual deductible cap.