I am enrolled in a PPO medical plan. My dependents and I have visited the doctor many times this year, but I was told by BCBS/Cigna that we haven’t met our annual deductible. How can this be?

With PPO medical plans, you pay a flat dollar amount (a copay) for many services, such as when you visit your primary physician, go to an urgent care clinic, or get a prescription filled. An example of a copay is $25.  Copays do not apply to your deductible but will count toward your annual out-of-pocket maximum.

You meet your deductible by paying out of pocket for medical services that require a deductible plus coinsurance until you reach your annual deductible amount.  Some services that require deductible and coinsurance are inpatient hospital care, outpatient surgery, advanced imaging services, ambulance services, and durable medical equipment. Once you have met your deductible, you only pay a percentage amount (your coinsurance) for such services.  An example of coinsurance is 20 percent of the allowed amount for a covered service.

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