Cost FAQs

IS THERE A LIMIT TO WHAT I MUST PAY FOR MY MEDICAL EXPENSES?

After you’ve met an annual deductible limit the plan places a limit – called the out-of-pocket maximum – on what you must pay in coinsurance each calendar year. Once you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the rest of the calendar year. There are separate in-network and out-of-network out-of-pocket maximums. 

Out-of-Pocket Maximum 

• In-network: $1,500/individual, up to $3,000/family (individual plus one or more at $1,500 individual)
• Out-of-network: $5,000/individual, up to $10,000/family (individual plus one or more at $5,000 per individual)

Note that the annual deductible as well as prescription drug and preventive care expenses do not count toward the out-of-pocket maximum. In addition, amounts over reasonable and customary charges as well as non-covered services do not accumulate to the out-of-pocket maximum. 

For more detailed information, click here.

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