What are the out-of-pocket costs that a member may have to pay?
The benefit summary in your plan booklet specifies the amounts and the types of out-of-pocket charges for covered services. Depending on the service and whether the provider is in-network or out-of-network, the UNICARE member may have to pay: • Copayment – the amount the member pays for each physician home or office visit. Network physicians agree to accept the member’s copayment and UNICARE’s reimbursement as payment-in-full for covered services if the plan pays 100% of the covered charge. If the Schedule of Benefits states that the plan pays less than 100% for physician office visits, the member may have additional out-of-pocket costs. • Deductible – the amount the member or covered family member must pay annually before UNICARE begins to pay for covered services other than in-network physician visits. Copayments do not count towards the annual deductible. The Schedule of Benefits states the amount of the deductible and whether it exists for both in-network services and out-of-networ
