Below are 3 scenarios of how a claim would be reimbursed, taking into account the plan deductible, reasonable and customary limits and reimbursement levels, using the example of a massage therapist who charges $130 for an hour long visit and the reasonable and customary limit is $126.
Scenario 1: Deductible has not been satisfied
| Summary Amount | |
| Submitted Amount | $130.00 |
| R&C Eligible Limit | $126.00 |
| Deductible Amount | $100.00 |
| Eligible Amount | $26.00 |
| Reimbursement % | 80% |
| Co-Insurance Amount | $5.20 |
| Plan Pays | $20.80 |
Scenario 2: Deductible has been satisfied
| Summary Amount | |
| Submitted Amount | $130.00 |
| R&C Eligible Limit | $126.00 |
| Deductible Amount | $0.00 |
| Eligible Amount | $126.00 |
| Reimbursement % | 80% |
| Co-Insurance Amount | $25.20 |
| Plan Pays | $100.80 |
Scenario 3: Deductible has been satisfied and Co-Insurance level met
| Summary Amount | |
| Submitted Amount | $130.00 |
| R&C Eligible Limit | $126.00 |
| Deductible Amount | $0.00 |
| Eligible Amount | $126.00 |
| Reimbursement % | 100% |
| Co-Insurance Amount | $4.00 |
| Plan Pays | $126.00 |
