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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.

 

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