Network providers have agreed to provide care at negotiated rates. This means that the dollar amount you pay for your share of covered expenses when you see a network provider is generally lower than what you'll pay when you use an out-of-network provider.

The following describes the basic cost-sharing features of KingCare^SM with respect to how benefits are paid.

The "annual deductible" is the amount you must pay each year toward covered expenses before Aetna begins paying. The KingCare^SM annual deductibles are as follows:

The deductible doesn't apply to certain covered services and supplies, including prescription drugs (which require copays), preventive care and hearing aids.

If three or more dependents (including yourself) together incur the total value of the family deductible for the plan in which you're enrolled, no further deductible will be required from any dependent for the rest of that year.

If you and your dependents are in the same accident, individual deductibles will be applied until the family deductible is met.

After you've met your annual deductible, you begin paying a percentage—"coinsurance"—of the allowed amount for most medical services and supplies until you reach the annual out-of-pocket maximum. Coinsurance doesn't apply to prescription drugs. (For details, see "Covered Expenses.")

You pay copays for prescription drugs at the time you receive your prescription. Copays don't apply to medical services other than emergency room care. (For details, see "Covered Expenses.")

"Reasonable and customary charges" are the allowable charges that Aetna will pay for medical services by contract with providers in its network. Rates are consistent with those normally charged by the provider for the same services or supplies and within the general range of rates charged by other providers in the same area for the same services or supplies. When you use a network provider, you pay only the coinsurance on the allowable charges. When you use an out-of-network provider, Aetna pays the allowable charges it would pay a network provider, and you pay the difference.

The "annual out-of-pocket maximum" is the most you pay in coinsurance for covered medical expenses each year. Once you reach your annual out-of-pocket maximum, KingCare^SM pays 100% for most covered expenses for the rest of that year. If you have three or more dependents (including yourself), each dependent's covered expenses accumulate toward the family out-of-pocket maximum.

The following don't apply to the annual out-of-pocket maximum:

The "lifetime maximum" is the maximum benefit amount you may receive from KingCare^SM during the course of your lifetime. The lifetime maximum applies only to medical services; there is no lifetime maximum for prescription drugs.

The lifetime maximum under KingCare^SM is $2,000,000 per covered person. Up to $20,000 of this maximum is restored automatically at the beginning of each calendar year for benefits paid during the previous year. Some expenses are also subject to annual or lifetime benefit limits. (For more information, see "Covered Expenses.")