Embedded deductible plans have one threshold for individual family members and a second overall cap for the entire family. Individual deductibles are often half the maximum amount.
Consider, for example, a policy with $5,000 individual and $10,000 family out-of-pocket deductibles. Perhaps dad met his $5,000 deductible early in the year following a surgical procedure. His medical care for the remainder of the year is covered at the co-insurance level outlined in the policy (often 80 percent). Mom and children remain subject to the $5,000 individual deductible until the entire family's accumulated medical bills for the year reach $10,000. At this point medical bills for all family members will be covered at the co-insurance level outline in the policy (again, 80 percent is common).
Check the policy's co-insurance requirement to verify your out-of-pocket responsibility once the individual and family deductibles are met. The figure is typically expressed as a percent (i.e. you pay 20 percent and the insurer pays 80 percent of the covered medical expense).
Aggregate deductible policies are a less confusing alternative. These policies have one out-of-pocket total figure for all covered family members.