2
   

Insurance says plan 1: 3000 individual, 6000 family. interpretation advise please

Forums: Contract Is Not Clear
Email this Topic • Print this Page
 
 
ramzi1978
 
Reply Wed 21 Oct, 2015 02:05 pm
hi,
my insurance plan, (plan 1 in particular) says for max out of pocket
3000 individual/ 6000 family.
when signing up, I understood it to mean that if an individual reaches 3000, then he maxes out. if the whole family (exmple 2 or 3 individuals) reaches the 6000 , then they max out.
so for example:
if I get a surgery and it costs 4000.
since i am individual, I pay 3000 .
however if I get surgery and it costs 4000, my wife also and my son also, then our max per family is 6000.

insurance is saying no...(go figure !)
they are saying it is 3000 if you select the individual plan and 6000 if you select the family plan.

can we discuss?
I am confused and on the way to going into debt
  • Topic Stats
  • Top Replies
  • Link to this Topic
Type: Question • Score: 2 • Views: 373 • Replies: 2
No top replies

 
ehBeth
 
  1  
Reply Wed 21 Oct, 2015 02:12 pm
@ramzi1978,
it is a $3000/person limit, to a family maximum of $6000

no one individual can claim more than $3000

eg.

family member 1 claims $2500
family member 2 claims $2500

the balance for family member 1 is $500 (from their $3000 limit)
the balance for family member 2 is $500 (from their $3000 limit)

the balance remaining for the family is $1000 (from the family $6000 limit), with no more available to #1 or #2 than their individual balances


eg.

family member 1 claims $3000
family member 2 claims $500

the balance for family member 1 is $0 (from their $3000 limit)
the balance for family member 2 is $2500 (from their $3000 limit)

the balance remaining for the family is $2500 (from the family $6000 limit), with no more available to #1 or #2 than their individual balances
0 Replies
 
ehBeth
 
  1  
Reply Wed 21 Oct, 2015 02:14 pm
@ramzi1978,
ramzi1978 wrote:

if I get a surgery and it costs 4000.
since i am individual, I pay 3000 .

however if I get surgery and it costs 4000, my wife also and my son also, then our max per family is 6000.


after your $4000 surgery, the insurer would pay $3000 (as that is the individual member limit) and there would be a family balance of $3000 available to claims made by your wife/son
0 Replies
 
 

 
  1. Forums
  2. » Insurance says plan 1: 3000 individual, 6000 family. interpretation advise please
Copyright © 2026 MadLab, LLC :: Terms of Service :: Privacy Policy :: Page generated in 0.03 seconds on 05/04/2026 at 06:46:07
▲ ▼