What is applied to the annual coinsurance maximum?
The annual coinsurance maximum is the maximum amount of coinsurance payments a member is required to make in connection with covered services or supplies in a contract year. The deductible, copayments, and amounts a member may have to pay in excess of contract benefit limits and benefit exclusions do not contribute to the annual coinsurance limit. Out-of-network deductible, copayments and coinsurance are not applied to in-network annual coinsurance limit.
The annual coinsurance maximum is the maximum amount of coinsurance payments a member is required to make in connection with covered services or supplies in a contract year. The deductible, copayments and amounts a member may have to pay in excess of contract benefit limits and benefit exclusions do not contribute to the annual coinsurance limit.
