Post by bjmza on Oct 19, 2015 23:38:28 GMT -5
Anyone know the difference between the Single Maximum Out-of-Pocket Limit ($500) and Single Plan Maximum Out-of-Pocket Limit ($6600) for our Humana plan? The only definitions I've been able to find are from the coverage document but nowhere can I find what determines which limit a charge applies to. We've current spent over $275 towards an individuals out of pocket limit plus and another $1000+ towards the same individuals plan maximum. We have no idea why some items fall in one category and not the other.
Single Out-of-Pocket Limits
Once a covered person satisfies the single out-of-pocket limits, this Plan will pay 100% of covered
expenses for the remainder of the calendar year for that covered person, unless specifically indicated,
subject to any calendar year maximums. The single out-of-pocket limits include the deductible and
coinsurance.
PLAN MAXIMUM OUT-OF-POCKET LIMIT
The Plan maximum out-of-pocket limit is the maximum amount of any PAR provider covered expenses,
including deductibles, coinsurance amounts and copayments and prescription drug copayments, that must
be paid by you, either individually or combined as a covered family, per calendar year before a benefit
percentage for PAR provider covered expenses will be increased. The PAR provider medical out-ofpocket
limit and the prescription drug out-of-pocket limit apply toward the Plan maximum out-of-pocket
limit. Once the Plan maximum out-of-pocket limit is met, any remaining PAR provider medical out-ofpocket
limit or prescription drug out-of-pocket limit will be waived for the remainder of the year. Any
applicable precertification penalties do not apply to the Plan maximum out-of-pocket limit.
Single Out-of-Pocket Limits
Once a covered person satisfies the single out-of-pocket limits, this Plan will pay 100% of covered
expenses for the remainder of the calendar year for that covered person, unless specifically indicated,
subject to any calendar year maximums. The single out-of-pocket limits include the deductible and
coinsurance.
PLAN MAXIMUM OUT-OF-POCKET LIMIT
The Plan maximum out-of-pocket limit is the maximum amount of any PAR provider covered expenses,
including deductibles, coinsurance amounts and copayments and prescription drug copayments, that must
be paid by you, either individually or combined as a covered family, per calendar year before a benefit
percentage for PAR provider covered expenses will be increased. The PAR provider medical out-ofpocket
limit and the prescription drug out-of-pocket limit apply toward the Plan maximum out-of-pocket
limit. Once the Plan maximum out-of-pocket limit is met, any remaining PAR provider medical out-ofpocket
limit or prescription drug out-of-pocket limit will be waived for the remainder of the year. Any
applicable precertification penalties do not apply to the Plan maximum out-of-pocket limit.