What is the Out-of-Pocket Coinsurance Maximum?
Once you have paid the maximum amount shown on your Schedule of Benefits in coinsurance, you will not have to pay any more coinsurance for the remainder of the Benefit Period, except for outpatient BH/SA services. If you utilize Non-Contracting Providers, you would still owe the difference between billed charges and the PHSIC Allowed Amounts even if you have met your Non-Network Coinsurance Maximum. Charges over the Allowed Amounts, Deductibles, penalties, outpatient BH/SA services, and copayments do not count towards either Network or Non-Network Maximum. Only the coinsurance you have paid counts.
