Annual Deductible

Under the PDP Option, if you elect coverage for yourself or yourself plus one dependent:

Each covered person must pay all eligible expenses until the individual deductible is met. Then, eligible expenses are covered at the coinsurance indicated for that expense.

After a covered person meets the individual deductible amount, that person will pay no further deductible.

If you elect coverage for yourself plus two or more dependents:

All expenses incurred by you and/or your covered dependents combine to meet the family deductible.

If no one person meets the individual deductible, but combined participant expenses meet the total deductible amount, no further deductible is required.

The maximum deductible any one covered person must pay is equal to the individual amount. After one person meets the individual deductible, that person will pay no further deductible, but other covered persons must continue to pay deductibles until the total is satisfied.

Please Note: There are separate deductibles (in-network and out-of-network) for restorative care.


An Example: Amounts Applied Toward In-Network Restorative Care Deductibles
On behalf of you	$50
On behalf of your spouse/domestic partner	$50
On behalf of child #1	$30
On behalf of child #2	$20
Total	$150
In this example, four people have met the family annual deductible for in-network restorative care. So, any other covered person's in-network restorative care would be reimbursed by the Plan, even if it were on behalf of a person who has not yet met the $50 individual annual deductible. No other covered family members need to meet their in-network restorative care deductible for the rest of the year. Please Note: No more than $50 of expenses per individual will be applied towards the family deductible.