An initial dollar amount that's the member’s responsibility. Benefits are paid only after this amount is met.

• For example, a member with a $1,000 medical deductible must pay $1,000 out of pocket before any benefits will be paid.
• Members can have multiple deductibles (individual, family, medical, dental deductible).

An accumulated maximum that changes the payment percentage once it's met. This might increase or decrease the payment percentage.

• Many plans provide a stop-loss provision which limits a member’s liability to the stop-loss amount.
• For example, if the stop-loss amount is $2,500, benefits will be covered at 100% after the member has paid $2,500 in deductibles, co-pays, and coinsurance.

The accumulation of days based on the from and through date billed.

• This is different from maximums, which use the quantity to count services. For example, an individual is allowed 30 chiropractor visits. Even though the individual had 15 different procedures done in one visit, the accumulator only increments by one.

The maximum dollar benefit that's paid for a member. This can be a lifetime or an annual maximum amount.

Note: Even with legislation that prohibits lifetime maximums on medical benefits, calendar, dental, orthodontic, vision, and prescription, maximums might still be applied.