Estimating Out-of-Pocket Expenses

To Estimate Your Out of Pocket:

Review Understanding Your Benefits for an overview of how your coverage works.

Read Verifying Coverage to determine if the service is:

Check your Outline of Coverage to determine your liability for the service.
Example: $30/visit.

Check the Outline of Coverage for any maximums for that service.
Example: 12 visits/year

Consult the table below:

If liability is...	Then..	Next Steps
No liability	Eligible services by participating/preferred providers covered in full.	No further action is needed.

Deductible	You must pay up to the deductible each calendar year before we provide benefits for certain services listed on your Outline of Coverage.	Check if you've met the deductible. (Call Customer Service for the most accurate deductible information.)

Coinsurance	We calculate the coinsurance amount by multiplying the coinsurance percentage by the Allowed Price after you meet your deductible (if applicable) and apply it towards your out of pocket limit (see below) for the calendar year.	Check if you've met the out of pocket limit. If so, eligible services by participating/preferred providers covered in full (Call Customer Service for the most accurate out of pocket information.)

Out of Pocket Limit	After you satisfy your out of pocket limit, you pay no coinsurance (see above) for the remainder of the calendar year.	Check if you've met the out of pocket limit. If so, eligible services by participating/preferred providers covered in full (Call Customer Service for the most accurate out of pocket information.)

Copayment	You must pay co-payments to providers for specific services shown on your Outline of Coverage.	No further action is needed.

Call customer service, 1-800-247-2583

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QUICK LINKS Understanding Your Benefits Verifying Coverage