Common use of Out-of-Network Annual Maximum Clause in Contracts

Out-of-Network Annual Maximum. This Policy has an out-of-network annual maximum for out-of-network non-orthodontic benefits. There is no annual maximum for the in-network pediatric dental essential health benefit. Once You have met the out-of-network annual maximum for non-orthodontic out- of-network Covered Services in the Schedule of Benefits section of this Policy, no more benefits will be payable for the remainder of that Plan Year. If you have other than individual coverage, the individual out-of-network annual maximum applies to each person covered under this Policy. Once a person within a family meets the individual out-of- network annual maximum, no more benefits will be payable for that person. If other than individual coverage applies, when persons in the same family covered under this Policy have collectively met the family out-of-network annual maximum in the Schedule of Benefits section of this Policy, no more benefits will be payable for the family for the remainder of that Plan Year.