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Out of Pocket Limit Family

The out-of-pocket limit is the maximum amount that a family has to pay for network deductible, coinsurance and copayments for covered medical expenses in a calendar year before benefits will be paid at 100 percent. The network out-of-pocket maximum protects a family from having to pay catastrophic medical bills in a given year. There is no family out-pocket-limit for out-of-network services.

Do these expenses count toward Out-of-Pocket Limit?

Included in Out-of-Pocket Limit

Not Included in Out-of-Pocket Limit

✔ Network calendar year deductibles

❌ Expenses in excess of the allowable charge

✔ Office visit copayments

❌ Expenses in excess of Plan maximum limits

✔ Telehealth provider visit copayments

❌ Utilization review penalties

✔ Prescription drug deductible

❌ Services not covered by the Plan including those found in the Limitations and Exclusions section

✔ Prescription drug copayments

❌ Generic drug differential amounts

✔ Emergency room copayments

❌ Services not considered medically necessary

✔ Network coinsurance paid for hospital inpatient services

✔ Network coinsurance paid for other covered medical expenses