What are the out-of-network medical benefits?
A.When you receive services from an out-of-network health care provider, your benefit is determined using the usual, customary and reasonable (UCR) allowance for the service. Therefore, since the UCR allowance may be less than what your doctor is charging, your out-of-pocket expense for an out-of-network service is not limited. You are always responsible for the difference between your doctor’s charge and the UCR allowance in addition to the deductible and coinsurance described below. You must satisfy a $200 individual calendar year deductible before any out-of-network benefits are paid. Once the deductible has been satisfied, the out-of-network benefit pays 80% of the UCR allowance if you are an Active Employee. If you are a Retiree who is not eligible for Medicare, the out-of-network benefit pays 70% of the UCR allowance. For example, lets assume you are an Active Employee and you undergo surgery with an out-of-network doctor. The doctor charges $2,000 for the surgery. Let’s also ass
