Deductible and Co-Insurance
The deductible is $500 per person, per plan year for In-Network charges. The deductible for Out-Of-Network is $1,000. After the deductible has been met, benefits will be paid at 80% for in network and 50% for out of network.
The deductible will be taken from the first bills submitted to insurance for covered expenses. The deductible may be met with charges from a combination of providers, physicians, hospitals, labs, etc.
Maximum Payment for You and Each Dependent
There is unlimited benefit amounts per person, per policy year.
Total Family Deductible
The total deductible for a family shall be three individual deductibles ($500 each person)
Carry-Over of Deductible
If during the last 90 days of the plan year, an insured person incurs eligible expenses which were applied to their deductible, such expenses will also be applied to his or her deductible for the following plan year.
Individual Out-Of-Pocket Maximum Expense Limit
The most you will have to pay out of pocket is $6, 350 per insured person, per policy year. Family Out-Of-Pocket maximum is $12,700 per policy year.