Deductibles & Out-of-Pocket Maximums

Deductibles & Out-of-Pocket Maximums

For PPO, in-network expenses count toward out-of-network limits (and vice versa).

How do deductibles work?

Individual Deductible

Once you meet your deductible, the plan will begin paying benefits.

Family Deductible

Once you meet the family deductible (whether or not you each meet your individual deductible) the plan will begin paying benefits.

How do out-of-pocket maximums (O-O-P) work?

If you are enrolled in a PPO, your out-of-pocket expenses will be limited by an annual out-of-pocket maximum.

Individual O-O-P

Once you meet your out-of-pocket maximum, the plan will pay any additional eligible expenses at 100% in-network and 100% up to reasonable and customary charges out-network for the rest of the calendar year. Deductibles, copayments for office visits and coinsurance apply toward the out-of-pocket maximum.

Family O-O-P

Once you meet the family out-of-pocket maximum (whether or not you each meet your individual out-of-pocket maximum) the plan will begin paying benefits at 100% in-network and 100% up to reasonable and customary charges out-network for the remainder of the calendar year. Deductibles, copayments for office visits and coinsurance apply toward the out-of-pocket maximum.