How does a deductible plan work?

Family Health Center's plan designs have an annual deductible

What is a deductible?

An annual deductible is an amount you may need to pay each benefit year before the plan will pay for covered services.

  • You may need to pay part or all of your medical bill(s) until you reach your total annual medical deductible.
  • If you have a family plan, your family annual medical deductible combines the annual medical deductibles paid by covered family members.

Services subject to the deductible

A service that applies toward your deductible is something that is performed in order to treat, maintain, or diagnose a condition or illness. These examples are services that are subject to your deductible:

  • Diagnostic x-rays and lab tests, such as pregnancy tests, allergy tests, throat cultures, ultrasounds, and cardiac stress tests
  • Outpatient and inpatient hospital care and surgery treatments and procedures, including setting of bones/casts, speech therapy, chemotherapy, injections, infertility/impotence services, and sleep studies

To see a complete list of services subject to the deductible, please check your Benefit Document, available from your secure online account at mytuftshealthplan.com.

Services NOT subject to the deductible

Preventive care services are not subject to the deductible and are covered in full, no charge, no copayment.

These are examples of non-preventive care services that require a copayment, but are NOT subject to the deductible:

  • Specialist consultations
  • PCP diagnostic or sick office visits
  • Outpatient substance abuse treatment and detoxification
  • Outpatient mental health care
  • Blood draws (when in conjunction with office visit or if doctor is present)
  • Sutures in office (when in conjunction with office visit or if doctor is present)
  • Prescriptions

To see a complete list of preventive care services and services NOT subject to the deductible, please check your Benefit Document, available from your secure online account at mytuftshealthplan.com.

Out-of-pocket maximum

The Out-of-Pocket Maximum is the limit on your out-of-pocket costs each benefit year. Both the Advantage HMO and the Select Advantage HMO plans have an Out-of-Pocket Maximum that includes the deductible, medical copayments, and prescription copayments. It does not include premium payments.

  • Individual Out-of-Pocket Maximum: $2000
  • Family Out-of-Pocket Maximum: $4000