decorative photograph
The Annual Coinsurance Maximum
Under Options 1 and 2, the annual coinsurance maximum is the maximum amount you must pay in coinsurance in a plan year toward eligible covered expenses.
The coinsurance maximum does not include the deductible, and there are separate coinsurance maximums for in-network and out-of-network charges.
The coinsurance maximum varies based on coverage level and TACC (see definition under "Defined Terms"), which provides greater financial protection for lower-paid employees, as shown in the following table.
The coinsurance maximum functions as your "financial safety net." It prevents you from having to pay very high health care expenses in the event of a serious medical situation. Once the coinsurance maximum is reached, the Medical Plan will pay 100% of negotiated fees for covered in-network care and 100% of the reasonable and customary charges for covered out-of-network services for the rest of the year.
Amounts that you pay toward your medical deductible and amounts above reasonable and customary charges for out-of-network care do not count toward your coinsurance maximum. In addition, prescription drug benefits are subject to a separate out-of-pocket maximum, as explained under "SPD Box Regular EndMarkerHow the Prescription Drug Plan Works
How the Prescription Drug Plan Works."
In- and Out-of-Network Coinsurance Maximums (Medical Only, Excludes Deductible and Prescription Drugs)
 
Option 1
 
Option 2
 
 
In-Network
Out-of-Network
In-Network
Out-of-Network
Total Annual Cash Compensation:
less than $60,000
       
Employee*
$1,000
$6,000
$2,750
$6,000
Employee + spouse/domestic partner or Employee + child(ren)
$1,500
$8,000
$4,125
$8,000
Family (employee + spouse/domestic partner + child(ren))
$2,000
$12,000
$5,500
$12,000
Total Annual Cash Compensation:
$60,000-$149,999
       
Employee*
$1,500
$6,000
$3,050
$6,000
Employee + spouse/domestic partner or Employee+ child(ren)
$2,250
$8,000
$4,575
$8,000
Family (employee + spouse/domestic partner + child(ren))
$3,000
$12,000
$6,100
$12,000
Total Annual Cash Compensation:
$150,000+
       
Employee*
$2,250
$6,000
$3,050
$6,000
Employee + spouse/domestic partner or Employee + child(ren)
$3,375
$8,000
$4,575
$8,000
Family (employee + spouse/domestic partner + child(ren))
$4,500
$12,000
$6,100
$12,000
* Also functions as a "per person" coinsurance maximum under the other coverage levels.