The Annual Deductible
Certain expenses are subject to an annual deductible. The annual deductible is the amount you must pay "up front" each calendar year before the Plan begins to pay benefits for certain covered expenses.
Under Plan Option 1 and Plan Option 2, there are certain services that are provided before the deductible (meaning the Plan begins paying immediately):
- Eligible preventive care that is received from in-network providers is covered in full at no cost to you without having to satisfy the deductible;
- For most routine services, such as primary care and specialist office visits, telehealth visits, basic laboratory services, urgent care, emergency room visits, ambulance, etc., you pay only the copayment — a fixed dollar amount — associated with each covered service.
- For more information on what is considered "eligible preventive care" and "primary care," please see the chart "Copayment or Coinsurance Paid for Covered Benefits."
Out-of-network care has a higher deductible that is separate from the in-network deductible. Amounts in excess of reasonable and customary (R&C) charges do not count toward the out-of-network deductible. As a reminder, the Prescription Drug Plan has a separate plan design from the Medical Plan designs listed in the following table.
In addition to separate deductibles for in-network and out-of-network medical care, the annual deductible you are subject to also varies by (1) your Total Annual Cash Compensation (TACC), and (2) your coverage level.