Paying for Your Care
When you receive medical care, you pay:
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required copays at the time of the service;
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coinsurance amounts not covered by Group Health; and
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expenses for services or supplies not covered by Group Health.
A billing fee may be charged by Group Health if copays or bills reflecting expenses not covered by the plan are not paid within 30 days of the billing date.
See " Covered Expenses" for details on copays and coinsurance; also see the latest new hire guides and annual open enrollment materials for details about monthly premiums you must pay (if any) for coverage.
Copay
You pay copays for medical care and prescription drugs at the time you receive service. (For details, see " Covered Expenses.")
Coinsurance
"Coinsurance" is the amount you and Group Health share toward covered expenses.
Annual Out-of-Pocket Maximum
The "annual out-of-pocket maximum" is the most you pay in copays for covered medical expenses each year. Once you reach the annual out-of-pocket maximum, Group Health 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 expenses don't apply to the annual out-of-pocket maximum:
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expenses not covered under your Group Health plan;
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health education;
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hearing aids;
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inpatient mental health;
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outpatient mental health;
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prescription drug copays; and
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residential day treatment.
Lifetime Maximum Benefit
There's no lifetime maximum benefit under Group Health.
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