Out-of-Pocket Maximum

The deductible does not count toward the out-of-pocket maximum.

Each calendar year after you reach the out-of-pocket maximum per person listed in the Schedule of Benefits, the Plan generally pays 100% of your remaining covered expenses during that calendar year, except for the following expenses:

• Treatment for infertility,
  
  
• Treatment received at a non-PPO Hospital, a non-PPO Ambulatory Surgical Facility, or treatment received from a non-PPO Physician, and
  
  
• Treatment for mental health and/or Substance Abuse.

The following expenses are not counted toward the out-of-pocket maximum:

• Deductibles,
  
  
• Treatment received at a non-PPO Hospital, a non-PPO Ambulatory Surgical Facility, or treatment performed by a non-PPO Physician,
  
  
• Treatment for mental health and/or Substance Abuse, and
  
  
• Treatment received for infertility.