Claimsadjudication, explained
All members

Marcus Chen

Enrolled in Bronze HDHP · Plan year 2026

Submit a claim

$3000.00 annual deductible, $7000.00 out-of-pocket max. Cosmetic isn't covered; Diagnostic lab at 30% coinsurance (after deductible, up to $1500.00/yr); Mri at 30% coinsurance (after deductible, needs review); Office visit at 30% coinsurance (after deductible, up to $600.00/yr); Physical therapy at 30% coinsurance (after deductible, up to $1000.00/yr).

Benefits used

Deductible The member pays toward this each year before the plan starts paying for deductible-eligible services.$1500.00 / $3000.00
Out-of-pocket max The most the member pays per year for covered services (deductible + copays + coinsurance). Once reached, the plan pays 100% of further covered costs.$0.00 / $7000.00
Diagnostic lab — annual limit The plan covers this benefit up to a yearly cap; amounts above the cap are the member’s responsibility.$0.00 / $1500.00
Office visit — annual limit The plan covers this benefit up to a yearly cap; amounts above the cap are the member’s responsibility.$0.00 / $600.00
Physical therapy — annual limit The plan covers this benefit up to a yearly cap; amounts above the cap are the member’s responsibility.$0.00 / $1000.00

Adjust usage

Set how much of the deductible and each capped benefit this member has already used, then submit a claim to watch the deductible finish or a limit exhaust. This is the only thing editable here — coverage rules belong to the policy.

Claims

No claims yet.