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Cost FAQs

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

Yes. 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. Note that, while prescription drug and preventive care expenses do not count toward the out-of-pocket maximum, the annual deductible is INCLUDED. In addition, amounts over Reasonable & Customary (R&C) as well as non-covered services do not accumulate to the out-of-pocket maximum. There are separate in-network and out-of-network out-of-pocket maximums. 

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