Benefit Choice open enrollment is an ideal time to consider ways to reduce your out-of-pocket costs. If you use out-of-network healthcare providers, please be aware your out-of-pocket costs may significantly increase. Staying in-network with your chosen health plan will help you get the greatest value from your benefits. For more details contact your plan administrator. See the plan administrator directory for phone numbers.
What does this mean?
Out-of-pocket maximum is the most you pay during a plan year before your health insurance starts to pay 100% for covered services:
- Includes – deductibles, coinsurance, and copayments.
- Does not include – premiums, remaining balances for out-of-network providers, and non-covered services such as dental care, cosmetic surgery, and long-term care.
For more information see page 12 of the Benefit Choice book.
What happens if I use an out-of-network provider?
Any costs over your plan’s allowable amounts are your responsibility and do not apply to the out-of-pocket maximum. The allowable amount is the maximum your health plan will pay for a given service. Allowable amounts were previously referred to as usual and customary charges.
Contact your plan administrator or University Payroll and Benefits (UPB).