The portion (percentage) of the charges that the plan pays after all deductibles have been satisfied.
For most services the following schedule applies until you reach the maximum amount of charges. Please see the Schedule of Benefits for a complete list of schedules and coinsurance rates.
After the maximum of $12,500 in covered charges has been reached for a family member in a calendar year, subsequent charges for that family member are paid at 100%.
Important: Only charges of PPO Providers are automatically considered "covered" for the purpose of the annual out-of-pocket maximum. Charges from other providers may exceed the amount allowed so you will have to pay the excess out-of-pocket, and these excess charges will not count towards the $12,500 maximum.