Annual Copayment Maximum Sample Clauses

Annual Copayment Maximum. Definition The Annual Copayment Maximum is the maximum amount you pay out of your pocket in a year. Once you meet the Annual Copayment Maximum you are no longer responsible for Cost Share amounts for eligible covered Services, unless otherwise noted under the When You Pay More section of this chapter. See the Benefit Summary section in the front of this Guide to see what your Annual Copayment Maximum amount is. When You Pay More The following amounts do not apply toward meeting the Annual Copayment Maximum. You are responsible for these amounts even after you have met your Annual Copayment Maximum.  Active&Fit or any fitness programs  Bariatric surgery program  Complementary alternative services such as chiropractic, acupuncture, massage therapy, or naturopathy  Cosmetic plastic surgery  Cosmetic dermatology  Dental services  Dressings and casts  Health education services, classes or support groups  HMO Flex services  Lasik eye surgery  Medical social services  Sexual dysfunction drugs  Payments for services subject to a maximum once you reach the maximum. See Benefit Maximum later in this chapter.  Take-home supplies  Travel immunizations  Any amounts you owe in addition to your Cost Shares for covered Services.  Payments you make for non-covered, excluded, or exhausted Services Note: It is recommended that you keep receipts as proof of your payments. All payments are credited toward the Accumulation Period in which the medical services were received. Annual Deductible Definition The Annual Deductible is the amount you must pay for certain covered medical Services in an Accumulation Period before KP will cover those Services. Once you meet the Annual Deductible, you are no longer responsible for deductible amounts for the remainder of the Accumulation Period, and you pay the Cost Share for the covered Services. Each member Annual Deductible counts toward the family unit Annual Deductible amount. Most HMO Plans do not have a deductible. Amounts paid as Member Rates for non-covered benefits or services do not count toward payment of a Deductible. See the Benefit Summary section in the front of this Guide to see if your plan has a Deductible, the amount, and what that Deductible applies to. How the Deductible Works For each Accumulation Period, only certain covered Services are subject to the Deductible, unless your plan does not have a Deductible. See the Benefit Summary section in the front of this Guide to see if your plan has a Deductibl...