UHC Out of pocket maximum

Situation

CHOICE PLUS

NETWORK

CHOICE PLUS

NON-NETWORK

Out-of-Pocket Maximum (OOPM)

The maximum you pay out of your pocket, in a Calendar Year for Copayments.

$1,500 per Covered Person per Calendar Year, not to exceed $4,500 for all Covered Persons in a family.

The Out-of-Pocket Maximum does not include the Annual Deductible.

$4,000 per Covered Person per Calendar Year, not to exceed $12,000 for all Covered Persons in a family.

The Out-of-Pocket Maximum does not include the Annual Deductible.

Situation

CHOICE PLUS

NETWORK

CHOICE PLUS

NON-NETWORK

Annual Deductible

The amount you pay for Covered Health Services before you are eligible to receive Benefits.

$500 per Covered Person per Calendar Year, not to exceed $1,500 for all Covered Persons in a family.

$1,250 per Covered Person per Calendar Year, not to exceed $3,750 for all Covered Persons in a family.