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Understanding the Tonik Health Plan Deductible

Aug 11, 2008
Let's check out deductibles in Tonik health insurance plans first since that is such an important part of any health plan. A deductible is an amount that you must pay first for certain benefits before the carrier starts to kick in.

For example, if you blow your knee out and it's $15,000 to repair (which isn't too far off) and your Tonik health plan has a $1500 deductible, you will need to pay the first $1500 of that $15,000 bill towards your deductible.

How in-network affects the deductible

The Tonik health plans are PPO plans. This means you can use any doctor but you will pay much less out of pocket when you use providers that are in Tonik's PPO network. You can check the the doctor network online to make sure your doctor or local hospital of choice is part of the network. In a true emergency (be real careful about this), Tonik will likely not hold you to a network but always try to use in-network providers anyway. Your definition of emergency may be different than the carrier's so you want to be careful.

Benefits carved out from the deductible

Tonik health insurance plans typically offer some benefits before the deductible is met. This usually occurs with office visits where you have a copay for the consultation and Generic RX wher eyou have a copay for generic medications. Some fo the Tonik plans also offer coverage for emergency room services with a copay that would normally be subject to the deductible with other health plans. For the office copay, some Tonik plans cap the number of copays in a calendar year afterwhich, office visits are subject to the main deductible. These copays give immediate coverage for more day-to-day benefits so they're a nice addition to the core health plan.

Deductible/Max out of pocket

Tonik health insurance is differenct from most insurance plans in that the deductible can also be the max out of pocket. The max out of pocket is important because it tells you when you will stop paying (assuming in-network, covered benefits) for the really big bills. Let's say you have a $50,000 hospital bill. With an in-network provider, your deductible/max out of pocket caps your expenses for covered benefits. Copays may continue but your big bills stop at the max. Most plans have a deductible after which, you pay a percentage until you hit the max out of pocket (two separate numbers). This combination of deductible/max out of pocket makes Tonik plans much cleaner and easier to understand...something that's rare in the health insurance market.

Choice of Deductible and pricing

The different plan options in Tonik are pretty simple as well. Outside of some copay differences, the real item changing is the deductible and the price. Want to lower your monthly premium? Pick a higher deductible. Essentially, you want to find the right of mix of deductible and monthly cost to fit both your budget and your tolerance for out of pocket expense if something happens medically.
About the Author
Dennis Jarvis is a licensed California broker with extensive knowledge of Tonik health insurance plans. Tonik health insurance plans
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