Additional Out-Of-Pocket Expenses

In addition to the annual deductible, copay-ment and coinsurance expenses discussed above, each individual is responsible for the following expenses:

• Expenses that exceed the “usual, customary and reasonable” charge.
• Expenses for services or supplies not medically necessary.
• Expenses for services or supplies not covered under this plan.
• Expenses not covered as a result of a benefit reduction under the medical review program (non-Medicare individuals only).
• Expenses which exceed benefit maximums.
• Expenses covered by Medicare even if the Medicare-eligible individual is not enrolled in Medicare.