Can someone please explain my health care benefits?

[annettemarie]

Specifically:

Deductible
(member's responsibility)
$ 900 per person
$1,350 member and child(ren)
$1,800 member and spouse
$1,800 member, spouse and child(ren)

and

Out-of-pocket limit
(member's responsibility; plan pays 100% after limit is reached; limit includes only deductible and coinsurance)
$3,500 per person
$7,000 member and child(ren)
$7,000 member and spouse
$7,000 member, spouse and child(ren)

Does this mean that my insurance deductible is met when my personal bills reach $900, or when my family's total bills reach $1800? And does it mean the most I will have to pay for my personal medical bills is $3,500 or that insurance doesn't kick in at 100% until we reach $7000?

I'm sorry if this sounds stupid, I just don't understand how it works. Although with a twin birth this year, I am assuming at some point the 100% will kick in. Sooner rather than later would be better though, LOL! Here's the whole link, if it helps.

[34me]

Your dedutable is $900. After that the plan will probably pay 80%. so when your 20% plus your deductable reaches $3500 you are done paying for you. Each of your babies may have their own deductable and co-insurance.

For us last year: our individual deductable is $400 with a coinsurance limit of $2000. Dd was seeing a psychologist at $125 a pop which was out of network so only $60 of that was counted toward our deductable. She did that 4 times ($240). She then had a bike accident in which she impaled herself on her handlebars to the tune of $15,690. We only had to pay $1640 worth of bills.

[annettemarie]

Oh good. $3500 is definitely better than $7000. I'm already halfway there.

[cristina47454]

The tricky thing about this, is that not everything goes toward your deductible. For example, well child visit were covered, but any sick child visits were my responsibility and DID NOT go toward the deductible bcs they were not covered by my plan (???). Baby had her own deductible after birth. A lot of the testing that you would assume are simply part of pregnancy care were not covered and DID NOT go toward my deductible. Read the fine print and ask lots of questions!! 19 months later and I'm still getting bills that the ins co. is just now getting around to denying.

[annettemarie]

Thanks, Cristina. I'll definitely check that out. And that's another question, I guess. When the twins are born, do they start each running their own tabs, so to speak?

[34me]

I think they do, but even though there are 2 it looks as if for you, children are there own group, so the max is $7000 no matter what their bill is