What are the new out-of-pocket coinsurance maximums for the PPO?

The out-of-pocket coinsurance is the maximum amount the individual pays after the deductible is met.  For example, an individual on the PPO would pay their deductible of $1,000, then 50% of the allowed amounts up to the out-of-pocket coinsurance maximum.  For the individual, this out-of-pocket coinsurance maximum amount is $1,500. 

In other words, on the PPO, an individual will pay the $1,000 deductible, then their portion of allowed amounts up to $1,500 for a total out-of-pocket of $2,500 (see equation below).

Deductible

+

Out-of-Pocket
Coinsurance Maximum

=

Total Out-of-Pocket

$1,000

$1,500

$2,500


On the PPO, a family will pay the $1,000 deductible for up to 3 family members, then their portion of allowed amounts up to $4,500 for a total out-of-pocket of $7,500 (see equation below).

Deductible

+

Out-of-Pocket
Coinsurance Maximum

=

Total Out-of-Pocket

$3,000
(1,000 x 3 family members)

$4,500

$7,500


Show All Answers

1. Why did my benefits change this year?
2. If I want all my insurance to remain the same, do I have to do anything?
3. Do I have to renew my Flexible Spending Account?
4. Do I have to renew my HSA?
5. Are there any changes to Dental coverage?
6. Are there any changes to the Vision coverage?
7. What does “Choice” mean in regard to physician co-pays?
8. Where can I go to see if my Dr. qualifies as a Choice provider?
9. What are the new monthly premiums?
10. Will my deductible be affected by the changes to the PPO?
11. What is the split for the PPO?
12. What are the new out-of-pocket coinsurance maximums for the PPO?
13. What is the change to Doctor’s Office visits under the PPO?
14. What are the changes to the prescription co-pays?
15. Where can I go to see which Tier my prescriptions are on and how much they will cost?
16. What has changed on the HSA?
17. What is the split for the HSA?
18. What are the new monthly premiums for the HSA?
19. Will my deductible be affected by the changes to the HSA?
20. What are the new out-of-pocket coinsurance maximums for the HSA?