Important Questions Answers Why This Matters definition

Important Questions Answers Why This Matters. What is the overall deductible? $425 Individual/$850 Family Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. Are there services covered before you meet your deductible? Yes. Certain preventive care, services that charge a copay, prescription drugs and emergency room services are covered before you meet your deductible. This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at xxxxx://xxx.xxxxxxxxxx.xxx/coverage/preventive-care-benefits/. Are there other deductibles for specific services? No. You don’t have to meet deductibles for specific services. What is the out-of-pocket limit for this plan? $1,825 Individual/$3,650 Family Prescription drug expense limit: $1,500 Individual/ $2,500 Family The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of- pocket limits until the overall family out-of-pocket limit has been met. What is not included in the out-of-pocket limit? Premiums, balanced-billed charges, and healthcare this plan doesn’t cover. Even though you pay these expenses, they don’t count toward the out-of-pocket limit Will you pay less if you use a network provider? Yes. See xxx.xxxxxx.xxx or call 0-000-000-0000 for a list of network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a xxxx from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of- network provider for some services (such as lab work). Check with your provider before you get services. Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral.