Deductible | Practical Law

Deductible | Practical Law

Deductible

Deductible

Practical Law Glossary Item 4-382-3390 (Approx. 4 pages)

Glossary

Deductible

This term has multiple meanings, depending on the context. In the context of:
  • Health plan compliance under the Employee Retirement Income Security Act of 1974 (ERISA), a cost-sharing amount that a participant or beneficiary must pay for a covered item or service, before the plan begins to pay for the item or service (see Practice Notes, Cost-Sharing Restrictions Under the ACA and Content Requirements for Summaries of Benefits and Coverage Checklist: Insurance, Medical, and Additional Terms). The structure of a plan's deductible may vary depending on the plan's design. For example, a health plan may have:
    • comprehensive deductible provisions, which aggregate the amounts the participant pays for all services in determining whether the deductible is satisfied; or
    • separate deductible provisions, which require that to receive a benefit, a participant must satisfy the deductible for that particular benefit (for example, a separate deductible for prescription drugs that the participant must satisfy before the plan will pay for prescription drugs).
  • Property insurance, the amount the insured must pay for a covered loss before the insurer must pay. Deductibles are described either as a specific dollar amount or a percentage of the insurable value of the property. Typically, lower deductibles result in higher insurance premiums. For additional guidance on property insurance, see Practice Notes, First-Party Property Insurance Policies and Property and Liability Insurance in Real Estate Transactions.
  • Mergers and acquisitions, an indemnification concept limiting a party's obligation with respect to small claims. A deductible provides that an indemnifying party does not have an obligation to indemnify until the amount of the indemnified party's losses exceed a certain agreed amount. Once that amount is reached, the indemnifying party is only liable for the amount of losses in excess of the agreed amount (sometimes referred to as an excess liability basket). Compare this to a threshold which provides that the indemnifying party is liable for the total amount of losses once the agreed amount is reached.