Cost FAQs

WHAT IS THE LM HEALTHWORKS PLAN OUT-OF-POCKET MAXIMUM?

The out-of-pocket maximum is the maximum coinsurance you pay during a calendar year.

There are separate in-network and out-of-network out-of-pocket maximums.

• In-network: $1,500/individual, up to $3,000/family (individual plus one or more at $1,500 per 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.

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