Coinsurance Paid for Covered Benefits
The following table shows the coinsurance percentage paid by the Medical Plan on an in-network and out-of-network basis for covered expenses. Please also see "SPD Box Regular EndMarkerWhat Is Covered
What Is Covered" for a more detailed list of covered expenses under the Medical Plan.
When you visit an in-network facility for a scheduled surgery, Options 1 and 2 will cover care provided by radiologists, anesthesiologists, and/or pathologists (RAPs) at the in-network percentage of the billed charges, even if the provider is considered an out-of-network provider.
For example, assume you visit an in-network facility for surgery and are treated by an out-of-network anesthesiologist whose charge is $500. The Plan will reimburse you 80% of the reasonable and customary (R&C) amount; if the R&C amount is $500 you would be reimbursed $400; you will be responsible for payment of the remaining $100. Fees for services provided by any other out-of-network specialists who attend to you while you are confined in an in-network facility will be paid at the out-of-network level of benefits. Services performed in an out-of-network facility will be paid at the out-of-network level of benefits.