A12: A calendar year deductible is the amount of covered medical expenses an individual pays each calendar year before benefits are paid by the plan. A co-payment is the fee charged by a health care professional to an individual for a covered medical expense or for covered prescription drug expenses.

No. Payment of your monthly premium is all that is required. We settle all claims on your behalf directly with the service provider.

Copayment - the dollar amount you pay for each in-network physician home or office visit. Physician copayments are for in-network care only. Network physicians agree to accept your copayment and UNICARE's reimbursement as payment-in-full for covered services if your plan pays 100% of the covered charge. If your Certificate of Coverage or plan booklet states that your plan pays less than 100% for physician office visits, you may have additional out-of-pocket costs.

Out-of-network providers do not participate in the Encore Health Network. Therefore, they have not agreed to keep their charges within your healthcare plan’s allowable amount. Out-of-network providers may charge any amount for services provided. Of course, you have the option of visiting an out-of-network provider at any time.

FIXED DEDUCTIBLES: If you choose this option your deductibles are $500 for collision and $1000 for theft, regardless of your vehicle value. This option is required by most leasing companies and lien holders. By choosing this option your premium will increase by a few percent, but in the event of a claim you will save significant money when compared to the Percentage Deductible option offered by most typical Mexico Auto Insurance policies.

Your deductible is $75 (for your term of service) so you must pay the first $75 in medical claims. When the insurance company gets a bill, they will look to see if you have submitted a prior claim and if not, they will subtract $75 from the bill as your responsibility. They then pay 80% of reasonable and customary charges per condition. For example, for your first claim, you would have to pay $75 and 20% of the balance.

The individual deductible is the amount of expenses that one individual must accumulate before their deductible is met. The family deductible is the amount that the all covered family together must accumulate before the deductible is met for all family members. Once the family deductible is met, no individual family member needs to accumulate additional expenses towards their deductible.

Deductibles are the first part of a claim that the Insured is responsible for. The deductible depends on the benefit the Insured is claiming for (ie. The Sect A Deductible is different then the Sect B deductible). The deductible is deducted per claim, per condition & per person and this is only deducted once at the beginning of each individual claim.

Dual eligible Medicaid enrollees have no deductibles. However, they are required to pay a nominal co-payment for each prescription. In 2007, there is a copayment of $1.00 for generic and $3.10 for brand name or specialty drugs. The co-payment will be $1.05 for generic and $3.10 for brand name drugs starting January 1, 2008.

Yes. Consult the Medicaid Update and Pharmacy Provider Manual for the billing policy and instructions. Providers may not bill dual eligible enrollees for Part B co-payments. Yes. Pharmacists are encouraged to pay attention to any special messaging they may receive through the claims processing system.

Medicaid pays the deductibles, coinsurance and premiums for Medicare Part A and B for low income persons. These individuals are called "Qualified Medicare Beneficiaries" or QMB's.

The published rates for all plans include a zero deductible. The following deductible options and savings are available for the Single-Trip Emergency Medical Plan and the Multi-Trip Emergency Medical Plan: Please note: Deductible amounts apply to emergency medical coverage only. Deductible options are not available on the Single-Trip All-Inclusive plans or the Multi-Trip All-Inclusive plans.

No. Calculating deductibles requires access to the "Common Working File," which we cannot obtain because we are neither a provider nor an FI.

Deductibles apply for some services, such as hospital care, including inpatient facility charges, outpatient facility, home health care, ambulatory surgery centers and lab/x-rays performed outside of a doctor’s office visit. They also may apply for out-of-network office visits.

Yes, there is a $200 per plan year deductible for medical services provided outside of UHS. The deductible does not apply to services with fees at UHS or to pharmacy claims.

If your WizeCare plan includes the Accident Medical Benefit, then you have a $100 deductible FOR THAT BENEFIT ONLY. Otherwise, there are no deductibles, and you may begin saving with WizeCare as soon as your membership is active.