Single? No kids? Not family enough
| Embedded Deductible OOPM 1 | |
| Plan Structure | The individual precedes the family deductible, which applies to the total combined expenses of all members. Any one or combination of covered members' cost can serve to meet the family deductible so that everyone benefits once that number is met. The ACA required a family OOP max coded even if it doesn't do much for ‘families’ of less than three members: single parents and childless couples 2 |
| Employer pros | Once the individual hits their limit everything is free for that individual but if the other family members continue with medical needs, they can still have bills up to their own individual limits or until the total family limit is reached. Significant cost savings for a healthy workforce. |
| Employer cons 3 | More complex to administer than traditional plans, risks dissatisfaction among employees who have high medical expenses and must juggle uncertain effects of multiple deductibles, making it harder to attract top-tier talent. Requires more expensive expertise to finesse communication with employees, more confidential health information handling. |
| Employee pros | Offers more flexibility when families grow 4 |
| Employee cons | Most complex structure to understand, with both family and individual deductibles to consider. In a workforce with less healthy worker demographics, families with high medical expenses experience more stress and higher upfront costs. |
1https://www.reddit.com/r/HealthInsurance/comments/1m40l3a/i_dont_understand_the_point_of_family_deductibles/
2https://www.cbo.gov/publication/59899
The Demographic Outlook: 2024 to 2054 | Congressional Budget Office
3https://www.google.com/search?q=embedded+deductible+fertility+profitability+analysis
4https://jamanetwork.com/journals/jama-health-forum/fullarticle/2838753
Improving Implementation of Fertility Preservation Benefit Mandates