Carryover Provisions are designed to aid the insured who has a claim in the last quarter of the year and has had no prior claims in the previous quarters.

• A. Carryover Provisions
• B. Stop Loss Feature
• C. Corridor Deductible
• D. Family Maximum

Answer: (A)

Carryover provisions deal with how deductibles are treated when charges spill over from one policy year into the next. They’re designed to help someone who has a big medical expense late in the year, especially when there were no prior claims earlier in the year. The idea is that the portion of the deductible that remains unmet by year end can be carried forward and applied to the next year’s deductible. So, if you paid or incurred a substantial amount in the last quarter, that amount can count toward meeting the deductible in the new year, reducing how much you still have to pay before benefits kick in.

For example, if your annual deductible is $2,000 and you have $1,500 of eligible expenses in the last quarter with no prior claims, the carryover provision allows that $1,500 toward deductible to be used against the new year’s deductible. In the new year, you would then only need to fulfill the remaining $500 before plan benefits begin. This cross-year treatment is what makes carryover provisions particularly useful in late-year situations.

Other features like stop loss, corridor deductible, or a family maximum address different aspects of cost-sharing or coverage within a year, not the transfer of unmet deductible amounts into the next year, which is why carryover provisions specifically fit this scenario.