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The Annual Out-of-Pocket Maximum
Under Options 1 and 2, the annual out-of-pocket maximum is the maximum amount you must pay in copays and out-of-network deductibles in a plan year toward eligible expenses, including prescription drug expenses.
There are separate out-of-pocket maximums for in-network and out-of-network charges.
The out-of-pocket maximum varies based on coverage level and TACC, which provides greater financial protection for lower-paid employees, as shown in the following table.
The out-of-pocket 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 out-of-pocket maximum is reached, you pay no copays for covered in-network care and out-of-network care for the rest of the year.
Amounts that you pay toward costs above the reasonable and customary charges for out-of-network care do not count toward your out-of-pocket maximum.
Annual Out-of-Pocket Maximums
(Medical AND prescription drug; out-of-network maximums are inclusive of deductible)
Coverage Levels
In-Network
Out-of-Network
 
Option 1
Option 2
Option 1
Option 2
Total Annual Cash Compensation*: less than $60,000
Employee
(Also serves as the "per person" maximum)
$2,500
$5,500
$10,000
$12,000
Employee + Spouse/Domestic Partner (DP) or Child(ren)
$4,000
$8,500
$16,000
$19,000
Employee + Spouse/DP + Child(ren)
$5,500
$11,500
$22,000
$26,000
Total Annual Cash Compensation*: $60,000 - $149,999
Employee
(Also serves as the "per person" maximum)
$4,000
$7,500
$10,000
$12,000
Employee + Spouse/DP or Child(ren)
$6,500
$11,500
$16,000
$19,000
Employee + Spouse/DP + Child(ren)
$9,000
$16,000
$22,000
$26,000
Total Annual Cash Compensation*: $150,000+
Employee
(Also serves as the "per person" maximum)
$5,500
$7,500
$10,000
$12,000
Employee + Spouse/DP or Child(ren)
$8,500
$11,500
$16,000
$19,000
Employee + Spouse/DP + Child(ren)
$12,000
$16,000
$22,000
$26,000
* Total Annual Cash Compensation (see "Total Annual Cash Compensation").