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A deductible is the amount you must pay each year for covered charges before benefits are paid by your plan.
What is a deductible?
Health insurance jargon is confusing. We feel your pain.
And while there may not be a way around the word deductible, there is a way through it.
A deductible is the amount of money you have to pay before health insurance kicks in and starts paying for medical treatment and services.
This is Jill. Jill has a $1,000 annual deductible.
Let’s say Jill falls out of a tree and breaks her arm.
She goes to her In-Network doctor and gets a bill for $700.
Jill will pay all $700 herself.
She still has $300 bucks left to meet her annual deductible for the year.
No insurance help yet.
In June, Jill twists her ankle while walking her dog.
This time her bill is $500.
Since Jill only has $300 to go to meet her deductible, her insurance covers the remaining $200.
However, some plans may include coinsurance and that will change the amount you owe.
Jill has now meet her Deductible. For the remainder of the year, Jill won’t have to pay towards her deductible. Horizon will start paying for all eligible services with the exception of your copay and/or coinsurance.
But in January, it starts all over again.
It is important to know that your Deductible is different than your copayment and coinsurance. Not all plans include all three types of member responsibility.
In Jill’s case, she had a copayment at the time she visited her doctor to fix her ankle that she paid in addition to the $300 payment that went to the Deductible.
Your plan may have a deductible, copayment and/or coinsurance.
To learn more about your plan, how much you have contributed to your deductible this year, and to verify your deductible, copayment and/or coinsurance amounts, visit HorizonBlue.com/members.
You can also get answers to your questions by reading our FAQs, sending us a question through Message Center or asking a question through chat.
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To get information about claims and the dollar amounts that have been applied to your deductible, sign in and follow the steps below:
- Click My Accounts.
- Then click Out of Pocket Expenses.
- Select the Benefit Period and click Export to see which claims applied to the deductible. Note: You can access this feature when signed in to your account from your computer (this option is not available to members on a mobile device such as a smartphone, tablet or notebook).
A deductible is the amount you must pay for covered health care services before your Horizon BCBSNJ plan begins to pay. For example, if your annual deductible is $1,000, you will need to pay for all of the covered health care services you receive (that are subject to your deductible), until you have reached $1,000. At that point, your coverage will kick in, and you will only be responsible for a copayment and/or coinsurance (if your plan includes coinsurance) on any covered services you receive through the rest of the year. Generally, your deductible resets at the start of the plan year.
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- How much was paid on my claim and what do I owe?
- How can I see which claims were applied to my deductible and maximum out of pocket (MOOP)?
- Why was my claim for services denied for being out of network?
- How can I update my information about additional insurance/coordination of benefits so I know my claim will be processed correctly?
Can't Find an Answer to Your Question?
Browse our Help Center categories and topics. For questions about your medical plan or technical support, sign in to send us an email or start a live chat. For other questions, visit the Contact Us information page on HorizonBlue.com.