Deductible and Co-Insurance
The deductible is $300 per person, per Plan year for In-Network Charges / $600 per person, per Plan year for Out-of-Network Charges.
After the deductible is met, Benefits will be paid at 80% of the Maximum Allowable for services rendered by Preferred Providers in the UniCare PPO Network. Services obtained by Out-of-Network providers (any provider outside the UniCare PPO Network) will be paid at 50% of Usual and Customary Charges.
The deductible will be taken from the first bills submitted to the insurance for covered expenses. The deductible may be met with charges from a combination of providers: physicians, hospital, lab, etc.
Maximum Payment for You and for
Each Dependent
Claims for a covered injury or sickness will be limited to a Maximum Aggregate Lifetime Benefit of $200,000.
Total Family Deductible
The total deductible for a family shall be three individual deductibles.
Carryover of Deductible
If during the last 90 days of the plan year, an insured person incurs eligible expenses which were applied to his or her deductible, such expenses will also be applied to his or her deductible for the following plan year.
Insurance Company (carrier) Information
