Once a family has paid the family medical deductible in a calendar year, all covered participants in that family will have satisfied their individual medical deductible for that calendar year.
The family medical deductible also applies when both husband and wife are covered separately as enrollees, and both are enrolled in Select Coverage. No individual family member may contribute more than $1,800 to the network family medical deductible, or more than $2,300 to the out-of-network family medical deductible.
The initial $3,600 of covered expenses will apply to both the network and out-of-network family medical deductible. After the initial $3,600 has been applied, only services rendered by an out-of-network provider will be applied to the additional $1,000 out-of-network family medical deductible.
The following expenses do not count toward the calendar year medical deductible:
Prescription drug deductible
Primary care office visit copayments
Telehealth provider visit copayments
Emergency room copayments
Prescription drug copayments
Generic drug differential amounts
Utilization review penalties
Expenses in excess of the allowable charge
Expenses in excess of Plan maximum limits
Services not covered by the Plan
Services not considered medically necessary