So how does the Two member max work? First, it really only applies when you have multiple people (three or more) on one health insurance policy in California. A single person or two people together will not be affected by the two member max.
Essentially,
for
three or
more
people
on one
policy,
each
person
is
working
towards
their
annual
deductible.
If two
people
meet
their
deductible,
the
other
family
members
will not
need to.
The
deductible
is the amount
you must pay
for medical
services
each year
before your
insurance
begins paying.
You can
find
more
in-depth
information
on
deductibles
in
California
health
plans
here.
It is
like a
horserace
where
each
person
is
accumulating
costs
towards
their
deductible.
The
first
two
across
the
finish
line let
the
other
family
members
stop
(working
towards
their
own
deductible).
With
most
health
plans on
the
market,
the
annual
deductible
(calendar
year Jan
1st
resets)
is per
person.
With the
two
member
max, it
protects
a family
from
having
to meet
four
deductibles
(for
example)
if four
family
members
all had
significant
medical
bills
during
the same
year.
The two
member
max
usually
applies
to the
annual
max out
of
pocket
as well.
The
out-of-pocket
max is
the
most you
will have to
pay in a
year for
deductibles
and
coinsurance
for covered
benefits.
You can
find
more
in-depth
information
on the
max-out-of-pocket.
This is
important
for the
same
reason
the cap
on
deductibles
is
important.
In
today's
world,
with the
high
cost of
medical
care
and the
higher
deductible
amounts,
if you
are
meeting
your
deductible,
you
are
probably
meeting
your max
out of
pocket
as well.
A simple
surgery
can
quickly
run
$20,000.
There
are some
exception
on the
California
health
market
for the
two
member
max.
You will
not see
the (x2)
designation
next to
these
plans.
HSA or
Health
Savings
Account
qualified
plans do
not have
the two
member
max
because
the
family
deductible
is
cumulative.
This
means
that if
two or
more
people
are on
the same
policy,
they are
all
working
towards
one
family
deductible.
The
family
deductible
is
usually
double
what the
single
deductible
is.
One
family
member
could
have
sizable
expenses,
in which
case,
he/she
would
need to
meet the
full
family
deductible.
This can
be an
advantage
or dis-advantage
depending
on how
the
costs
hit the
family
members.
Some of
the new
plans on
the
individual
and
family
side are
individual
policies
regardless
of the
entire
family
enrolling.
The new
no-deductible
plans
such as
Blue
Cross
Right
Plan $40
(which
is very
popular)
are
separate
policies.
If a
family
applies
for this
plan,
they
will be
individually
split on
to
separate
individual
policies
on the
membership
front.
So in
summary,
the two
member
max is
to
protect
a family
from
multiple
deductibles
and max
out of
pockets
in a
calendar
year.
Other
important
concepts
to help
you
understand
two
member
max
are:
Co-pay
Deductible
Co-insurance
max out
of
pocket
Catastrophic
health
insurance
HSA or
Health
Savings
Account
