Medical Plans

A deductible, used for medical and dental plans, is the amount you pay toward the cost of covered expenses before the plan begins to share in the cost with you.

Your plan deductibles run for January 1–December 31 each year.

Coinsurance is a set percentage of service costs that you will be expected to pay once you have met your annual deductible.

When your annual deductible is met, your insurance provider pays for their portion of the full cost of the service and you pay the coinsurance, or remaining percentage.

Your deductible and out-of-pocket maximum exclude expenses that are not covered by the plan, such as cosmetic surgery. The cost for services denied by the plan are not include in your deductible or out-of-pocket maximum, whether or not you pay them.

They also exclude any penalties and amounts in excess of allowed amount charges billed by out-of-network providers.

An out-of-pocket maximum is an annual cap on the dollar amount you are expected to pay out of your own pocket for services (including deductibles, copays, and coinsurance) throughout the plan year.

Once you meet the out-of-pocket amount, your insurance provider will cover 100% of remaining covered medical expenses for the year.

The out-of-pocket maximum excludes noncovered expenses and amounts in excess of allowed amount charges billed by out of network providers.