For the out-of-pocket maximums, the "per person" rule allows the employee or any covered dependent(s) (e.g., spouse/domestic partner or child) to reach an individual out-of-pocket maximum, after which the out-of-pocket maximum is satisfied for the year for that person. Covered individuals who have not met the out-of-pocket maximum may combine to meet the remainder of the out-of-pocket maximum for that particular coverage level. If no one person has met the individual out-of- pocket maximum, the expenses of all covered individuals can combine to meet the out-of-pocket maximum for that coverage level.

Note: There are separate safety nets for in-network and out-of-network services. The out-of-network, out-of-pocket maximum calculation does not include amounts above reasonable and customary (R&C) charges if you use out-of-network providers. An R&C limit is based on data in your area and determined to be an appropriate fee for a specific medical service.

Example: John is enrolled in Option 1, has TACC less than $60,000 and is covering his spouse and 2 children. John's spouse, Mary, has a complicated surgery and is in an in-network hospital for 4 days. The out-of-pocket expenses related to Mary will be $2,500 — the individual out-of-pocket maximum — not $4,000 (hospital inpatient copay of $1,000 per day for 4 days). Now that Mary has paid $2,500 and met the individual out-of-pocket maximum, all other eligible in-network expenses for Mary for the rest of the year will be covered at 100% by the plan. John and his children will continue to pay copays for in-network services they use during the year until: