Deductibles and copays – sorting it all out
OEBB health plans provide quality health benefits for you and your family. You pay nothing for annual physicals or preventive prescription drugs. But what about everything else? Let's brush up on how you pay for care in the OEBB plans.
If you go to the doctor or need a prescription filled for any other reason, you'll pay part of the cost before your benefits kick in.
Some of our plans feature a copayment or "copay" for certain doctor visits or prescriptions. This is a flat amount you pay, and the plan pays the rest.
Most of our plans also have a deductible. This means, unless the service you receive is "deductible waived" (e.g., preventive care), you pay 100% of the cost until you have paid this amount which is referred to as "meeting your deductible."
After you have met your deductible, you pay a percentage of the cost (called coinsurance) and the plan pays the rest. Your coinsurance may vary based on the plan you are enrolled in and the service you receive, but it's very common on OEBB plans for you to pay 20% and the plan to pay 80%.
You should also be aware that OEBB plans have annual "out-of-pocket" maximums to protect you if you need a high amount of medical care. All your copays and coinsurance payments are tracked by plan year. If the total you pay "out-of-pocket" reaches that maximum, the plan will pay 100% of your covered services for the rest of the plan year.
Keep in mind that the OEBB plan year runs Oct-Sept, so each year your deductible and out-of-pocket maximum resets on October 1st. If your spouse or family member is on a health plan with a different employer, their deductibles and out-of-pocket maximums may reset in January. Be sure to factor in this timeline when planning for doctor's visits or procedures.
Click the links below to review your plan details.
Kaiser Permanente Medical Plans