Reasonable and Customary Charges

2020 and 2021 Plan Year Information

Out-of-Network Reimbursements

Out-of-network reimbursements are based on eligible expenses as determined by the Plan administrator. You are responsible for any payments required to the provider in excess of the reasonable and customary amount.

Amounts paid to out-of-network providers count toward the in-network and out-of-network annual deductible. The amount you pay toward your annual deductible is included in your out-of-pocket maximum.

Non-Preventive Services

For non-preventive health care services, including office visits, coinsurance will apply after you have met your annual deductible. That means you will pay a percentage of the cost of services (coinsurance) rather than a flat fee (copay). The amount you pay in coinsurance plus the annual deductible during the year will not exceed your annual out-of-pocket maximum.