4Q deductible carryover
Medical plan portion of the plan
All Priority Health medical plans with deductibles have a fourth-quarter deductible carryover (except Priority
). The carryover automatically credits any deductible met in the last quarter of a 12-month plan year against the next plan year's deductible. Employees are able to satisfy their deductibles sooner and begin receiving coinsurance benefits.
The credit amount tends to change throughout the year due to the nature of fourth-quarter claims lag. As fourth-quarter deductible claims are processed, they're credited toward the next plan year's deductible on a prospective basis.
HRA portion of the plan
The HRA is separate from the medical plan and has no fourth-quarter deductible carryover. When the HRA requires employees to pay the first portion of their deductible:
- Credit only offsets the employee's medical plan deductible.
- The employee is still fully responsible for the "pays-first" obligation of their HRA deductible.
When a carryover reduces the employee's "pays-first" responsibility
The only time a fourth-quarter deductible carryover can reduce an employee's "pays first" responsibility is when that carryover is larger than the employer's contribution to the HRA.