Back

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

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, and
     
  • Treatment received for infertility.