Important Questions
| Important Questions | Answers | Why ithis matter |
| What is the overall deductible? | $500 person / $1,000 family Doesn’t apply to preventive care | You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible |
| Are there other deductibles for specific services? | Yes. $300 for prescription drug coverage. There are no other specific deductibles. | You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services. |
| Is there an out–of– pocket limit on my expenses? | Yes. For participating providers $2,500 person / $5,000 family For non-participating providers $4,000 person / $8,000 family | The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses. |
| What is not included in the out–of–pocket limit? | Premiums, balance-billed charges, and health care this plan doesn’t cover. | Even though you pay these expenses, they don’t count toward the out-of-pocket limit. |
| Is there an overall annual limit on what the plan pays? | No. | The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. |
| Does this plan use a network of providers? | Yes. See www.[insert].com or call 1-800-[insert] for a list of participating providers. | If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers. |
| Do I need a referral to see a specialist? | No. You don’t need a referral to see a specialist | You can see the specialist you choose without permission from this plan. |
| Are there services this plan doesn’t cover? | Yes. | Some of the services this plan doesn’t cover are listed on page 4. See your policy or plan document for additional information about excluded services. |
