![]() ![]() When the total amount of Out-of-Pocket applied per all Covered Persons in a family unit equals the Family Out-of-Pocket maximum, then the Out-of-Pocket maximum is considered to have been met for the entire family. This means that any Family member who meets the individual Out-of-Pocket Maximum will receive 100% Benefits for Covered Services, before the Family Out-of-Pocket Maxi- mum is met.The Summary of Benefits provides the Calendar Year Out-of-Pocket Maximum amounts for Partic- ipating Providers and Non-Participating Providers at both the individual and Family levels. The Family Out-of-Pocket Amount and the Per Member within a Family Out-of-Pocket Amount applies. Out-of-pocket expenses are the costs of medical care that are not covered by insurance and that you need to pay for on your own, or 'out of pocket.' In health insurance, your out-of-pocket expenses include deductibles, coinsurance, copays, and any services that are not covered by your health plan. This means an individual family member can meet the individual Out-of-Pocket Maximum before the entire Family meets the Family Out-of-Pocket Maximum. ![]() If you have a Family plan, there is an individual Out-of-Pocket Maximum within the Family Out-of-Pocket Maximum. The amount of the Family Out-of-Pocket Maximum is described in the benefit schedule section of the Policy.BENEFIT SCHEDULEThe following is the Policy benefit schedule, including medical, prescription drug and pediatric vision benefits.Īny amount you have paid toward the Out-of-Pocket Maximum for your individual plan will be applied to both the individual Out-of-Pocket Maximum and the Family Out-of-Pocket Maximum for your new plan. Non-compliance penalty charges do not apply to the Family Out-of-Pocket Maximum and will always be paid by you. Once the Family Out-of-Pocket Maximum has been met in a Year, You and Your Family Member(s) will no longer be responsible to pay Coinsurance or Copayments for medical or Pharmacy services for Covered Expenses incurred during the remainder of that Year from Participating Providers.Įach Insured Person can contribute up to his or her Individual Out-of-Pocket amount toward the Family Out-of-Pocket Maximum. Examples of Family Out-of-Pocket in a sentence ![]()
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