Deductible Coinsurance Order One Bill Tool

Description

Apply deductible first, then coinsurance to the excess, limiting patient payments by remainingOutOfPocket and assigning the remainder to insurerPaid.

Health-benefit calculations depend on explicit eligibility flags, coverage periods, caps, exclusions, and payment order. Applying supplied arithmetic is separate from determining actual insurance terms or a legally payable claim.

Apply deductible first, then coinsurance to the excess, limiting patient payments by remainingOutOfPocket and assigning the remainder to insurerPaid.

When to use this tool

Use Deductible Coinsurance Order One Bill when you need one transparent benefit or reimbursement component under a declared rule.

How to use the tool and how it works

Enter allowed, remainingDeductible, coinsurance, remainingOutOfPocket. Use the units and conventions below.
Run the tool. Correct any format, range, or cross-field input error before interpreting the output.
Read deductiblePaid, coinsurancePaid, patientPaid, insurerPaid. Use the output convention below.

Require nonnegative allowed and remaining deductible and out-of-pocket amounts and coinsurance in [0, 1]. Apply deductible first, then coinsurance to the excess, limiting patient payments by remainingOutOfPocket and assigning the remainder to insurerPaid.^[1]

Input field	Meaning and units	Accepted input
allowed	Allowed	Required. Finite number; minimum 0.
remainingDeductible	Remaining Deductible	Required. Finite number; minimum 0.
coinsurance	Coinsurance	Required. Finite number; minimum 0; maximum 1.
remainingOutOfPocket	Remaining Out Of Pocket	Required. Finite number; minimum 0.

Output field	Interpretation	Returned shape
deductiblePaid	Deductible Paid	Required. Finite number.
coinsurancePaid	Coinsurance Paid	Required. Finite number.
patientPaid	Patient Paid	Required. Finite number.
insurerPaid	Insurer Paid	Required. Finite number.

json

{
  "input": {
    "allowed": 1000,
    "remainingDeductible": 200,
    "coinsurance": 0.2,
    "remainingOutOfPocket": 500
  },
  "output": {
    "deductiblePaid": 200,
    "coinsurancePaid": 160,
    "patientPaid": 360,
    "insurerPaid": 640
  }
}

Limitations and assumptions

This is one supplied bill model without network status, exclusions, copays, accumulator eligibility, policy verification, or claim adjudication; all amounts share currency.
Inputs must satisfy both the field types and the cross-field conditions above. Invalid input causes an error; a successful false flag or documented placeholder is a different result.
Numeric calculations use binary floating point unless exact decimal-integer arithmetic is explicitly stated. No hidden measurement tolerance or decimal rounding is added; nonfinite or out-of-contract results are rejected. Numeric signed-zero results are exported as zero.

Alternative or Complementary methods

Confirm policy terms, verified enrollment, claim eligibility, and appropriate accounting or legal interpretation before relying on a payment result.

References

Calculation and input contract: health-policy/deductible-coinsurance-order-one-bill — tool.io

Similar or alternative tools

Insurance Copayment Cap One Claim Term
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Insurer Out Of Pocket Remaining Cap
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