WHAT IS OUT- OF- POCKET (COINSURANCE)?
The Traditional medical plan option has a coinsurance limit. The coinsurance limit is $2,500 for individuals and $5,000 for a family. This is the maximum amount you must pay in a calendar year in deductibles and coinsurance, but excludes amounts you pay that exceed “reasonable and customary” amounts. Once the limit has been reached, the plan pays in full, not to exceed the reasonable and customary, for covered services for the remainder of the year. Amounts applied towards coinsurance limits in the last three months of the calendar year do not carry forward to the next year.
