“How Much Will You Actually Pay with Health Insurance?”
“Deductibles, coinsurance, and out-of-pocket costs explained simply”

#Deductible s  Calendar Year & Co Pays

Deductible – The Calendar Year amount you must pay for specific Covered Services before the plan  pays for Covered Services pursuant to this [policy] Agreement.  ^{Sample EOC Page 107}

Example from 2022 Silver 70 PPO

See evidence of coverage – Cost concepts in action 2024  Page 42

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#Co-Payments – Specific Covered Services 

Footnote #2 Calendar Year Deductible (CYD): 

• Calendar Year Deductible explained. A Calendar Year Deductible is the amount you pay each Calendar Year before Blue Shield pays for Covered Services under the Plan.
• If this Plan has any Calendar Year Deductible(s), Covered Services subject to that Deductible are identified with a check mark () in the Benefits chart above.
• Covered Services not subject to the Calendar Year medical Deductible. Some Covered Services received from Participating Providers are paid by Blue Shield before you meet any Calendar Year medical Deductible. These Covered Services do not have a check mark () next to them in the “CYD applies” column in the Benefits chart above.
• This Plan has a separate medical Deductible and pharmacy Deductible.
• This Plan has a separate Participating Provider Deductible and Non-Participating Provider Deductible.
• Family coverage has an individual Deductible within the Family Deductible. This means that the Deductible will be met for an individual with Family coverage who meets the individual Deductible prior to the Family meeting the Family Deductible within a Calendar Year. Any amount you have paid toward the individual Deductible will be applied to both the individual Deductible and the Family Deductible. Once the individual Deductible or Family Deductible is reached, cost sharing applies until the Out-of-Pocket Maximum is reached.
• The PAF Co-Pay Relief Program, one of the self-contained divisions of PAF, provides direct financial assistance to insured patients who meet certain qualifications to help them pay for the prescriptions and/or treatments they need. This assistance helps patients afford the out-of-pocket costs for these items that their insurance companies require.  Patient Advocate Foundation *

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