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  1. nottake

    nottake Junior Member

    Español / España
    Hello everybody,

    I want to arrange an insurance policy because next year I'm going to study at USA. The university set some mandatory requisites for privacy policies, one of them is the following:

    "deductible should not exceed &100 per illness or injury, with a maximum out of pocket expense of $3.500 per illness or injury".

    I dont know what is the meaning of "maximum out of pocket expense of $3.500". In addition, I dont understand the meaning of "deductible".

    Someone can help me? Thanks!
  2. Cathoos Junior Member

    USA, English
    Hola Nottake,

    This is a kind of tricky thing to explain. A deductible is what you pay with your own money (what your insurance doesn't cover). What they are saying is that let's say you are over here in the U.S. and you break your leg. You must pay $100 first and then your insurance will cover the rest of the expenses. An out of pocket expense means what you pay out of your own wallet. So, they are also saying that you shouldn't pay more than $3,500 per illness or injury. Your deductible should be a relatively small amount, like $100 because if you have to pay $3,500 out of pocket it's kind of like 'what's the point of having insurance', right? The sentence seems contradictory to me, but maybe someone who has experience in the medical industry would be able to explain this a little easier.

  3. Big Lar Senior Member

    República Dominicana
    US (English)
    Ambos terminos tienen que ver con la cantidad de dinero que tu tienes que gastar antes de que la compania de seguro empieza a sufragar tus gastos.

    "Deductible" es cuando tu te enfermas o te lastimas, tienes que pagar al maximo $100. "Out of pocket expense" es como suena - el dinero que sala de tu bolsilla. No entiendo por que hay una diferencia en las cantidades. Si has pagado $100 (y dicen que "el deductible is not to exceed" esa cantidad), porque dicen que la maxima cantidad que puedes pagar es $3,500? Es una cuestion de como operan las companias de seguro - no del idioma.
  4. Mirlo

    Mirlo Senior Member

    Castellano, Panamá/ USA
    El "out of pocket" es la suma total de pagos que tiene que hacer el cliente o familia cubierta por el seguro.
    Out of pocket= de su propio bolsillo o por cuenta propia

    El deducible es la cantidad inicial que tú pagaras para cubrir los servicios (médicos/medicinas, etc.)


    a clause in an insurance policy that relieves the insurer of responsibility to pay the initial loss up to a stated amount

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