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Special Medical Plan Features
Nurse Care Manager–
Available 24/7, care
coordinators can provide information to help you make
more informed health care decisions. Call any time
when you want to learn more about a recent diagnosis,
a minor sickness or injury, men's, women's, and
children's wellness, how to take Prescription Drugs
safely, self-care tips and treatment options, healthy
living habits, or any other health related topic.
NurseLine is available to you at no cost.
Call: 1-800-459-2110 ext 2132
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Out-of-Pocket Maximum
The annual Out-of-Pocket Maximum is the most you pay
each calendar year for Covered Health Services. If your
eligible out-of-pocket expenses in a calendar year
exceed the annual maximum, the Plan pays 100% of
Eligible Expenses for Covered Health Services through
the end of the calendar year.
Expenses incurred for the following are not be applied
toward the Out-of-Pocket Maximum:
- Premiums;
- Any charges that exceed eligible expenses;
- Any charges for non-covered health services.
Medical Insurance
To Fit Your Needs
Key Benefit Terms
COBRA
A Federal law that allows workers and dependents
who lose their medical, dental or medical flexible-
spending account coverage to continue any of these
benefits for a specified length of time by electing
and paying for continuation benefits.
Coinsurance
Coinsurance is the percentage of Eligible Expenses
that you are responsible for paying. Coinsurance is
a fixed percentage that applies to certain Covered
Health Services after you meet the Annual
Deductible.
Copayment (Copay)
A Copayment (Copay) is the amount you pay each
time you receive certain Covered Health Services.
The Copay is a flat dollar amount and is paid at the
time of service or when billed by the provider.
Copays do not count toward the Annual Deductible.
If the Eligible Expense is less than the Copay, you
are only responsible for paying the Eligible Expense
and not the Copay.
Annual Deductible
The Annual Deductible is the amount of eligible
expenses you must pay each calendar year for
Covered Health Services before you are eligible to
begin receiving Benefits. The amounts you pay
toward your Annual Deductible accumulate over
the course of the calendar year.
Amounts paid toward the Annual Deductible for
Covered Health Services that are subject to a visit
or day limit will also be calculated against that
maximum benefit limit. As a result, the limited
benefit will be reduced by the number of days or
visits you used toward meeting the Annual
Deductible.