Massachusetts Health & Accident Insurance Practice Exam

What is the Per-Cause deductible requirement?

1. It is a single deductible for all types of care

2. Insured must meet the deductible every time for a new claim

3. Deductibles are waived for preventive care

4. It applies to only outpatient services

The correct answer is: Insured must meet the deductible every time for a new claim

The concept of a Per-Cause deductible requires the insured to meet a specific deductible amount for each new claim or event. This means that for every individual claim made under the policy, the insured is responsible for paying the deductible amount before the insurance coverage kicks in. This requirement can lead to multiple deductibles being applicable throughout the coverage period, depending on how many different claims an insured has. This approach is relevant in distinguishing it from the other deductible types, such as aggregate deductibles where a single deductible amount applies to all claims in a specified period, or policies that may waive deductibles for certain types of care, like preventive services. Understanding this principle is essential for both consumers and professionals in health insurance to navigate costs effectively.