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Deductible
The fixed dollar amount you must pay each calendar year before benefits subject to the annual deductible become available. You cannot pay the annual deductible amount to us in advance. You must meet the deductible on a claim by claim basis.
| Coverage | Amount |
|---|---|
| Individual | $0 |
| Family | $0 |
Out-of-Pocket Maximum
The maximum deductible, copayment and coinsurance amounts you pay in a calendar year. Once you meet the coinsurance maximum you are no longer responsible for deductible, copayment, or coinsurance amounts.
| Coverage | Participating Provider | Non-Participating Provider |
|---|---|---|
| Individual | $600 | $1,100 |
| Individual Drug | $5,000 for prescription drugs and supplies | |
| Family | $1,800 | $3,300 |
| Family Drug | $7,500 for prescription drugs and supplies | |
Please refer to your Description of Coverage (DOC) and Prescription Drug Plan Certificate (DRC) for additional information. In the case of a discrepancy between this website and the language contained within the DOC or DRC, the latter will take precedence.