Aggregating specific deductibles must be met by one or more members combined.

Aggregating specific deductibles must be met by one or more members combined.

• A. True
• B. False
• C. Not applicable
• D. Only applies to SL

Answer: (A)

In many group or shared-risk plans, a specific deductible isn’t tied to a single person. The deductible can be funded by contributions from one or more members combined. The idea is to spread the burden of meeting the deductible across the group, so once the aggregated payments reach the specified deductible amount, the insurer then pays the remaining eligible costs according to the policy terms. For example, if a plan has a specific deductible of 20,000 and two members contribute 12,000 and 8,000 toward a claim, the deductible is met and coverage applies thereafter. This shared-amount approach is why aggregating specific deductibles must be met by combined member contributions.

In many group or shared-risk plans, a specific deductible isn’t tied to a single person. The deductible can be funded by contributions from one or more members combined. The idea is to spread the burden of meeting the deductible across the group, so once the aggregated payments reach the specified deductible amount, the insurer then pays the remaining eligible costs according to the policy terms. For example, if a plan has a specific deductible of 20,000 and two members contribute 12,000 and 8,000 toward a claim, the deductible is met and coverage applies thereafter. This shared-amount approach is why aggregating specific deductibles must be met by combined member contributions.