Meaning and Explanation of an Insurance Deductible
In general insurance, a deductible is a provision in the insurance contract whereby the policyholder agrees to pay a certain amount for each covered loss in return for a reduced premium.
An insurance deductible is an amount of a covered loss that a policyholder must pay before the claim is paid in full by the insurance company. The deductible is subtracted from the total amount of the insurance settlement and applies only to your damages. A deductible typically applies for each claim made in a policy year.
A deductible in health insurance works slightly differently but is still a risk-sharing provision. A deductible in health insurance is paid once per policy year, which is required before the insurance company pays out on any claim. A deductible is paid only once a policy year in health insurance.
A deductible is a cost-sharing provision meant to reduce the number of smaller claims, reduce claims costs for insurance companies, and lower the overall premium for the policyholder.
Losses under your deductible are paid by you, which allows the insurance company to pass on the cost savings in the overall premium to you. The use of deductibles also promotes prevention consciousness.
Deductibles on Car Insurance
Deductibles on car insurance are similar to deductibles found in any other type of insurance product.
Most deductibles on personal vehicle insurance are tied to physical damage coverage such as collision, comprehensive and all-perils coverages. For example, you may have a $500 deductible on collision coverage and $300 for comprehensive. Another popular scenario is either a $500 or $1,000 on All-Perils coverage.
Deductibles on personal vehicle insurance are typically exclusive to physical damage coverages. However, it’s not unusual to see commercial vehicles with a deductible on liability coverage.
Here’s an example of how a deductible works for a personal auto insurance claim:
- Jimmy struck a light post causing repairable damage to the front of his vehicle.
- Jimmy has a $500 deductible on his collision coverage.
- The total damages to his vehicle are $5,000.
- Jimmy would need to pay the first $500 and the insurance company would pay the remainder.
- Jimmy pays the repair shop his $500 deductible to take his repaired vehicle back
- The insurance company is invoiced the remaining $4,500
Deductibles and Co-insurance on Home Insurance
Deductibles and co-insurance clauses on home insurance work similarly to other general insurance products.
A home insurance deductible is paid each time a claim is submitted. This is different than health insurance where a deductible is only paid once a policy term.
Co-insurance in property insurance policies forces the policyholder to assume a share of the risk on a partial or total loss. Co-insurance on home insurance is typically expressed as a percentage, very similar to co-insurance in health insurance.
The purpose of a co-insurance clause in home insurance is to motivate the policyholder to maintain a specified amount of insurance in relation to the value of the property. If the policyholder does not maintain a specified amount, relative to the value of the property, the policyholder or insured would share with the insurance company any partial or total loss.
The minimum amount of insurance required by most insurance companies is 80% of the actual cash value of the property, to have full indemnification. However, it’s always best practice to insure up to 100% of the property value as many prefer not to shoulder that risk.
Co-insurance allows a policyholder to save money on the premium by under-insuring, but at the expense of potentially having to share in a covered loss.
Deductible vs Premium
A deductible is a provision in the insurance contract where you agree to pay a specified amount each time you decide to put in a claim. The exception to this rule is seen in health insurance where a deductible is only paid once, in each policy term.
For example, an auto insurance policy with a $500 deductible on collision coverage means that you are responsible for the first $500 of the claim, and the insurance company pays the remainder.
In health insurance, a policyholder may have a $100 annual deductible that needs to be paid only once before the insurance company can cover a claim. Claims submitted after the initial deductible is paid are not subject to further deductibles.
An Insurance Deductible is Completely Different Compared to Insurance Premium.
The premium is the total cost of an insurance policy. The premium is made up of the following:
- Pure Premium – is the amount required to pay claims.
- Development Factors – are adjustments to reserves needed to pay out claims which have yet to be settled
- Trend Factors – adjustments applied to all losses to reflect what they would probably cost the following year.
- Acquisition Costs – Costs incurred by the insurance company to conclude a contract of insurance with the policyholder. Acquisition costs typically include a commission to the insurance broker or agent, and advertising and promotional expenses.
- Administrative Costs – expenses that the insurance company needs to operate the business. Examples could be leasing or buying a building, equipment, and employee salaries.
- Profit – revenue after all expenses are paid.
As you can see, the insurance premium is something completely different than a deductible.
Copay vs Deductible
The differences between a co-pay and deductible clause are tied to the context of health insurance. This is because co-payable clauses aren’t seen in general insurance.
A co-pay or co-payable clause in health insurance means that you’d need to pay a small amount each time a covered service is used or purchased.
A deductible in health insurance is the amount you’d need to pay, every year before any benefit becomes payable under the insurance policy.
It’s not unusual for health insurance policies to be subject to both a deductible and copay.
Here is an example:
- Sarah has health insurance with an annual deductible of $100
- Sarah has a copay clause of $8.00 for prescription drugs.
- Sarah incurs $75 in prescription drugs
- Sarah needs to pay the one-time annual deductible of $100
- Sarah must pay both her annual deductible of $100 and $8.00 for the prescription drugs
Co-insurance vs Deductible
Co-insurance in health insurance is a clause in the insurance policy, which specifies a percentage you need to pay each time a covered service or product is claimed. Co-insurance is very similar to co-pay in health insurance but differs in that the contribution is expressed as a percentage, whereas a co-pay provision is a specified amount.
A deductible is a specified amount that you’d need to pay, every policy renewal before the insurance company pays out on any claim.
What is a deductible in health insurance?
A deductible in health insurance is the amount you’d need to pay, every year policy renewal before any benefit becomes payable under the insurance policy.
Example: John has a health insurance policy with a $200 annual deductible. John goes to see the dentist for teeth cleaning and incurs a $400 dentist bill. Before the insurance company pays for the covered loss, John needs to pay for the first $200. Therefore, John pays $200 and the insurance company pays the remaining $200. John will not be subject to any further deductible in that policy year after the initial annual deductible of $200 is paid.
A disappearing deductible is a deductible that reduces in amount each year, expressed as a specific dollar amount or a percentage.
The purpose of a disappearing deductible, (also called a vanishing deductible), is to reward policyholders with a reduced deductible for every policy term that they remain accident-free. Disappearing deductibles promote customer loyalty and offer more value to the policyholder.
Here is an example of how a disappearing deductible works:
- John has a $1000 All-Perils deductible on his 2020 Honda Pilot
- John purchased a “disappearing deductible” insurance floater, rated at 20% off the $1,000 deductible for every year that he remains accident-free.
- John gets into a single-vehicle accident in 2025 and puts in a claim for the damages to his vehicle.
- John would normally be responsible for the $1,000 deductible, but because he had been accident-free for 5 years up to the time of the accident in 2025, the deductible would have completely vanished.
- 20% of $1,000 is $200. John saved $200 every year on his deductible. $200 x 5 = $1,000
- John does not have to pay for his entire deductible.
Keep in mind, that insurance companies who offer “disappearing deductibles” may have slight variations. Always read the policy wordings before committing to a purchase!