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.
* Total Annual Cash Compensation (see "Total Annual Cash Compensation").