What's a deductible?
The amount you must pay before your healthcare plan begins paying benefits. Let's say the plan has a $450 individual deductible. You have to pay 100% of your covered healthcare costs until you've paid at least $450. After that, your co-insurance kicks in, and you pay only 20% of the costs for covered services from in-network providers (the plan pays 80%). Certain preventive services are covered 100% regardless of the deductible.

What's a MOOP (maximum out-of-pocket)?
The most you'll have to pay during a plan year for covered services after your deductible is met. After the MOOP amount is reached, the plan pays 100% of the costs for covered services for the rest of the plan year.

Under the Caterpillar healthcare plans, only the amount you pay for medical claims (not prescription claims) counts toward your MOOP. There's also a federal MOOP that applies to medical AND prescription claims. Once the federal MOOP is met, you don't have to pay medical or prescription co-pays/co-insurance.

Why is there such a big difference between an individual premium and an individual + spouse premium?
Market research shows that, on the whole, the cost of the spouse's healthcare is greater than the employee's. The premium for an individual + spouse enrollment tier reflects that.

What's the rationale for charging one premium for family coverage vs. by number of dependents?
Based on industry benchmarking, it's uncommon to differentiate family premiums by the number of dependents. Caterpillar is following this best practice.