All GIC Employee and Non-Medicare retiree/survivor health plans include a calendar year deductible. The in-network deductible is $250 per member to a maximum of $750 per family. This is a fixed dollar amount you must pay before your health plan begins paying benefits for you or your covered dependent(s). These deductible amounts are less than half of those charge by the majority of employers.

Deductible Questions and Answers

Q) What is a deductible?

A) This is a fixed dollar amount you must pay each calendar year before your health plan begins paying benefits for you or your covered dependent(s).  This is a separate charge from any copays.

Q) How much is the in-network calendar year deductible?

A) The deductible is $250 per member, up to a maximum of $750 per family.

Here is how it works for each coverage level:

  • Individual: The individual has a $250 deductible before benefits begin.
  • Two-person family: Each person must satisfy a $250 deductible.
  • Three- or more person family: The maximum each person must satisfy is $250 until the family as a whole reaches the $750 maximum.

If you are in a PPO-type plan, the out-of-network deductible is $400 per member, up to a maximum of $800 per family; this is a separate charge from the in-network deductible.

 

Q) If I change health plans, am I subject to another deductible??

A) Although GIC health benefits are effective each July, the deductible is a calendar year cost. 

You will not be subject to a new deductible if:

You stay with the same health plan carrier but switch to one of its other options.

You will be subject to a new deductible if:

You choose a new GIC health plan carrier.

Q) Which health care services are subject to the deductible?

A) The lists below summarize expenses that generally are or are not subject to the annual deductible. These are not exhaustive lists.  You should check with your health plan for details.  Also, as with all benefits, variations in these guidelines below may occur, depending upon individual patient circumstances and a plan’s schedule of benefits.

Examples of in-network expenses generally exempt from the deductible:

  • Prescription drug benefits
  • Outpatient mental health/substance abuse benefits
  • Office visits (primary care physician, specialist, retail clinics, preventive care, maternity and well baby care, routine eye exam, occupational therapy, physical therapy, chiropractic care and speech therapy)
  • Medically necessary child and adult immunizations
  • Wigs (medically necessary)
  • Hearing Aids
  • Mammograms
  • Pap smears
  • EKGs

Examples of in-network expenses generally subject to the deductible

  • Emergency room visits
  • Inpatient hospitalization
  • Surgery
  • Laboratory and blood tests
  • X-rays and radiology (including high-tech imaging such as MRI, PET and CT scans)
  • Durable medical equipment

Q) How will I know how much I need to pay out of pocket?

A) Upon request, plans are now required to tell you before you incur a cost the amount you will be required to pay.  Call your plan or visit their website to get this information.

When you visit a doctor or hospital, the provider will ask you for your copay upfront.  After you receive services, your health plan may provide you with an Explanation of Benefits, or you can call your plan to find out which additional portion of the costs you will be responsible for. The provider will then bill you for any balance owed.

 


This information provided by the Group Insurance Commission.