Once the applicable deductible has been met, the Plan pays a portion of the allowable charge for covered medical expenses. The participant pays the remainder in the form of coinsurance.
Any fees charged by an out-of-network provider that are more than the allowable charge are not part of the coinsurance amount. The Plan will not pay any portion of these charges.
Do these expenses count toward the Coinsurance Maximum?
YES | NO |
|---|---|
Coinsurance for hospital inpatient services | Calendar year deductible |
Coinsurance for other covered medical expenses | Preventive medications deductible |
Telehealth provider visit copayments | |
Emergency room copayments | |
Prescription drug copayments | |
Generic drug differential amounts | |
Utilization review penalties | |
Expenses over the allowable charge | |
Expenses over Plan maximum limits | |
Services not covered by the Plan | |
Services not medically necessary |