Bob won’t need to pay out-of-pocket for deductibles, copays or co-insurance for the rest of the policy year for his care however, services for his covered spouse and child would be subject to cost sharing until either their individual out-of-pocket maximum is met or the family out-of-pocket maximum is met. Bob is the first in his family to reach $5,000 in expenses. For example, say Bob’s plan has an individual out-of-pocket maximum of $5,000 and family out-of-pocket maximum of $10,000. Generally, once an individual has reached their out-of-pocket maximum most care for that person is covered at 100% ― but, the other family members keep paying. A family out-of-pocket maximum adds up all the family members costs for deductibles, coinsurance and copays when calculating whether the maximum is met or not. If you cover a dependent or have multiple dependents under a family plan, there will be an individual out-of-pocket maximum and a family out-of-pocket maximum that is two times the individual out-of-pocket dollar maximum.If your plan covers health service provided out-of-network, then depending on the design of the plan, you may have different out-of-pocket maximums for in-network and out-of-network services.
0 Comments
Leave a Reply. |