Embedded Deductible and OOP example needed

Where is @douglan when you need him?

I need examples and I cannot find anything when I search the SOA site. 3 people (my lawyer, me and HR) are arguing the embedded-ness and when and where to apply the individual and family deductibles in the family plans (We are definitely AOK on the EE only policies). Hopefully someone here sees this and has already drawn up an example and will share with me.

Anyone?
TYVM

Don’t you have a claims department? (I guess not, if you are in consulting.)

Or is this for something completely new to your company, such that no one knows how these claims will be processed?

Most of this has been worked out, by claims folks and lawyer folks, who have hammered all this out before allowing the sale of such policies.
(Now, if they didn’t… well, they will eventually.)

Me? No idea.

Tacking back:
What particular situation are you thinking of, for which you have no answer?