BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Calendar Year Deductible
Individual
$1,500 per person
$3,000 per person
Family Maximum
$3,000 per family
$6,000 per family
Family Maximum Calculation Individual Calculation:
Family members meet only their individual deductible and then their claims will be covered under the plan coinsurance; if the family deductible has been met prior to their individual deductible being met, their claims will be paid at the plan coinsurance. Combined Out-of-Pocket Maximum for Medical and Pharmacy expenses
Individual
$4,000 per person
$8,000 per person
Family Maximum
$8,000 per family
$16,000 per family
Family Maximum Calculation Individual Calculation:
Family members meet only their individual Out-of-Pocket and then their claims will be covered at 100%; if the family Out-of-Pocket has been met prior to their individual Out-of- Pocket being met, their claims will be paid at 100%.
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