Out-of-pocket expenses are defined as the expenses a member incurs when satisfying the plan's deductible and coinsurance requirements. The deductible and coinsurance level varies based on where treatment is delivered as shown in the table below. The total annual out-of-pocket expense limit is calculated by adding the deductible and coinsurance maximum together. In this example, it is $3,250. Deductibles must be satisfied before any benefit is paid. Coinsurance is applied as a percentage of the payable medical charges. This percentage is only applied to care delivered inside the U.S. and varies depending on whether the care is delivered in-network or out-of-network.
Global Navigator Plan |
Deductible |
Coinsurance Maximum |
|
Outside U.S. |
U.S.in Network |
U.S.out of Network |
|
$250 |
$125 |
$250 |
$500 |
$2,000 |
Out of Pocket Expense Example
Member is covered under the Global Navigator 250 plan and receives services from an in-network hospital in the U.S.
Payable medical expenses are $20,000, the $250 deductible must be satisfied, and 20% coinsurance applies.
A member is only responsible for $2250 in out-of-pocket expenses. This is due to the fact that there is a Coinsurance cap of $2,000.