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Claim Reports Examples

Here are some examples that help explain how copays, coinsurance and deductibles are computed that you might see on the Medical Mutual app or on your account on

We have individual deductibles on our medical plan of $100 with a $200 max for a family.  In this example you can see that the family deductible has been met and coinsurance has been required on at least one claim.  The coinsurance maximum of $800 family is also displayed.

In this example $609 was billed, but medical mutual only agreed to pay $339.21 ($609 charge - $269.79 discount).

The $100 deductible applied first leaving $239.21.  Then our 10% co-insurance was charged (10% of $239.21 = $23.92).  Total member responsibility is $100 deductible + $23.92 co-insurance = $123.92

In this example for an office visit in January 2021 the copay was $20.  As of February 2021 office copays are $15.

Copays do not apply toward a deductible.

$48 was billed and coinsurance was applied.  The insurance discount took the original $48 bill and subtracted their $19.74 discount so that $28.26 was owed to the provider.  10% of $28.26 is $2.83, the member portion of the bill since the deductible was already met.

For preventative services there is no copay or coinsurance – they are fully covered.

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