Annual Deductible means the amount, which the patient must pay each calendar year for covered expenses before the Fund becomes liable for its share of such expenses.
Annual Deductible means the amount set forth in the Coverage Schedule which each Member must pay each Calendar Year before Benefits will be paid by the Plan.
Annual Deductible. Amount: $0 Formulary Type: Comprehensive+ Number of Cost Share Tiers: 4 Tier Initial Coverage Limit: $4,660 True Out‑of‑Pocket Amount: $7,400 Retail Pharmacy Network: P1 The name of your pharmacy network is listed above. The Aetna Medicare pharmacy network includes pharmacies that offer standard cost‑sharing and pharmacies that offer preferred cost‑sharing. Your cost‑sharing may be less at pharmacies with preferred cost‑sharing. You may go to either type of network pharmacy to receive your covered prescription drugs. The pharmacy network includes limited lower‑cost, preferred pharmacies in Suburban Arizona, Suburban Illinois, Urban Kansas, Suburban & Rural Michigan, Urban Michigan, Urban Missouri, Rural North Dakota, Suburban Utah, Suburban West Virginia, and Suburban Wyoming. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. To find a network pharmacy, or find up‑to‑date information about our network pharmacies, including whether there are any lower‑cost preferred pharmacies in your area, please call Member Services at the number on the back of your member ID card or consult the online Pharmacy Directory at Xxx.XxxxxXxxxxxxx.xxx. Members who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays. Every drug on the plan’s Drug List is in one of the cost‑sharing tiers described below: • Tier One – Generic drugs • Tier Two – Preferred brand drugs • Tier Three – Non‑preferred brand drugs • Tier Four – Specialty drugs: Includes high‑cost/unique brand and generic drugs To find out which cost‑sharing tier your drug is in, look it up in the plan’s Drug List. If your covered drug costs less than the copayment amount listed in the chart, you will pay that lower price for the drug. You pay either the full price of the drug or the copayment amount, whichever is lower. Important Message About What You Pay for Vaccines — Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information. Important Message About What You Pay for Insulin — You won’t pay more than $35 for a one‑month supply of each insulin product covered by our plan, no matter what cost‑sharing tier it’s on. Initial Coverage Stage: Amount you pay, up to $4,660 in total covered prescription drug expenses. Standard Cost Share: The chart below lists the amount that you pay at a pharmacy that offers standard cost‑sharing: Initial Cov...
Examples of Annual Deductible in a sentence
The Annual Deductible does not apply to Preventive Care, Dental Services and Vision Services.
Once the Participant meets his applicable Annual Deductible, the Plan will begin to pay Covered Benefits, subject to any required Coinsurance, in accordance with and as governed by Section 4.1. The applicable Annual Deductible is set forth in Appendix A to this Plan.
Solely for purposes of this Plan, the Annual Deductible will operate on a combined basis with the Annual Deductible (both the “Network/ONA” and “Non-Network Benefit” annual deductibles) applicable in the AT&T Medical Plan.
Coverage Type Coverage Description In-Network Out-of-Network Annual Deductible A Preventative 100% 100% N/A B Basic Restorative 100% 80% $50 Individual/$100 Family C Major Restorative 50% 50% $50 Individual/$100 Family D Orthodontia 50%* 50%* N/A Maximum Annual Benefit $1,250** $1,000** * Orthodontia has a lifetime maximum benefit of $1,000 for dependents age 19 and under.
This includes rebates for those drugs that are administered to you before you meet your Annual Deductible.
More Definitions of Annual Deductible
Annual Deductible applies to each Calendar Year of the District’s Plan which will be July 1- June 30th. Family Maximum Deductible/Retiree Family Maximum Deductible – If eligible medical expenses equal to the Family Maximum Deductible are incurred collectively by 3 or more family members during a Calendar Year (July 1 – June 30th) and are applied toward Individual Deductibles, the Family Maximum Deductible is satisfied. A “family” includes a covered Employee and his covered dependents. Deductible Carry-Over – Eligible Expenses incurred in the last 3 months of a Calendar Year (July 1 – June 30th) and applied toward that year’s Deductible can be carried forward and applied toward the person’s Deductible for the next Calendar Year. OUT-OF-POCKET MAXIMUMS Individual Out-of Pocket Maximum Family Out-of Pocket Maximum Network $2,500 $6,250 Non-Network $5,000 $12,500
Annual Deductible applies to each Calendar Year of the District’s Plan which will be July 1- June 30th. Family Maximum Deductible/Retiree Family Maximum Deductible – If eligible medical expenses equal to the Family Maximum Deductible are incurred collectively by 3 or more family members during a Calendar Year (July 1 – June 30th) and are applied toward Individual Deductibles, the Family Maximum Deductible is satisfied. A “family” includes a covered Employee and his covered dependents. Deductible Carry-Over – Eligible Expenses incurred in the last 3 months of a Calendar Year (July 1 – June 30th) and applied toward that year’s Deductible can be carried forward and applied toward the person’s Deductible for the next Calendar Year. OUT-OF-POCKETMAXIMUMS Network Non-Network Individual Out-Of-Pocket Maximum $2,500 $5,000 Family Out-Of-Pocket Maximum $6,250 $12,500 Individual Out-Of-Pocket Maximum – Except as noted, a Covered Person will not be required to pay more than $5,000 (or $2,500 for Network services and supplies) in a Plan Year (July 1 – June 30th) toward Eligible Expenses which are not paid by the Plan. Once he has paid his out-of-pocket maximum, his Eligible Expenses will be paid at 100% for the balance of the Plan Year (July 1 – June 30th). Family Out-Of-Pocket Maximum – Except as noted, a Covered family (Employee and his Dependents) will not be required to pay more than $12,500 (or $6,250 for Network services and supplies) in a Plan Year (July 1 – June 30) toward Eligible Expenses which are not paid by the Plan. Once the family has paid their out-of-pocket maximum, his Eligible Expenses will be paid at 100% for the balance of the Plan Year (July 1 – June 30th) NOTE: Out-Of-Pocket expenses that count toward the maximum include deductible, co-pays and coinsurance. The Out-Of-Pocket does not apply to or include expenses which become the Covered Person’s responsibility for failure to comply with the requirements of the Utilization Management Program. WARNING: The Out-Of-Pocket maximum does not apply to expenses which exceed the Plan’s limits or which are not covered. For instance, the Plan will never pay benefits for expenses which are in excess of Usual, Customary and Reasonable. The Non-Network out-of-pockets are the maximum out-of-pockets that will be required. For Network providers, however, only the lesser maximums will apply.
Annual Deductible is defined in Section 3.2.
Annual Deductible. Amount: $0 Formulary Type: Open 2 Plus Number of Cost Share Tiers: 4 Tier Initial Coverage Limit: $4,430 True Out-of-Pocket Amount: $7,050 Maximum Out-of-Pocket Amount $1,500 Once your individual out-of-pocket expenses reach this amount, you will pay $0 for all covered prescription drugs for the remainder of the plan year. Retail Pharmacy Network: P1 The name of your pharmacy network is listed above. The Aetna Medicare pharmacy network includes pharmacies that offer standard cost-sharing and pharmacies that offer preferred cost- sharing. Your cost-sharing may be less at pharmacies with preferred cost-sharing. You may go to either type of network pharmacy to receive your covered prescription drugs. The pharmacy network includes limited lower-cost, preferred pharmacies in Suburban Arizona, Suburban Illinois, Urban Kansas, Rural Michigan, Urban Michigan, Urban Missouri, and Suburban West Virginia. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. To find a network pharmacy, or find up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call Member Services at the number on the back of your member ID card or consult the online Pharmacy Directory at XXX.XxxxxXxxxxxxx.xxx. Members who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays. Every drug on the plan’s Drug List is in one of the cost-sharing tiers described below: • Tier One – Generic drugs • Tier Two – Preferred brand drugs • Tier Three – Non-preferred brand drugs • Tier Four – Specialty drugs: Includes high-cost/unique brand and generic drugs To find out which cost-sharing tier your drug is in, look it up in the plan’s Drug List. If your covered drug costs less than the copayment amount listed in the chart, you will pay that lower price for the drug. You pay either the full price of the drug or the copayment amount, whichever is lower.
Annual Deductible. Amount: $0 Formulary Type: GRP B2 Number of Cost Share Tiers: 5 Tier Initial Coverage Limit: $4,430 True Out-of-Pocket Amount: $7,050 Retail Pharmacy Network: S2 The name of your pharmacy network is listed above. To find a network pharmacy, or find up-to- date information about our network pharmacies, please call Member Services at the number on the back of your member ID card or consult the online Pharmacy Directory at XxxxxXxxxxxxXxxxx.xxx. Every drug on the plan’s Drug List is in one of the cost-sharing tiers described below: • Tier One – Preferred generic drugs: Includes low-cost generic drugs • Tier Two – Generic drugs: Includes generic drugs • Tier Three – Preferred brand drugs: Includes preferred brand drugs and some high-cost generic drugs • Tier Four – Non-preferred drugs: Includes non-preferred brand drugs and some higher-cost generic drugs • Tier Five – Specialty drugs: Includes high-cost/unique brand and generic drugs To find out which cost-sharing tier your drug is in, look it up in the plan’s Drug List. If your covered drug costs less than the copayment amount listed in the chart, you will pay that lower price for the drug. You pay either the full price of the drug or the copayment amount, whichever is lower.
Annual Deductible means the total deductible amount as specified in the Schedule of Benefits, which shall be borne by the Policyholder or the Insured(s) for each Period of Insurance before any benefit under Section A to Section D of the Benefits Provisions becomes payable.
Annual Deductible. Individual/Family (1) — Includes both medical and prescription drugs (2) In-Network (4) $1,500/$3,000 $2,200/$4,700 $3,200/$6,450 Out-of-Network $5,600/$11,300 $8,000/$16,000 $10,000/$20,000 Coinsurance (Plan Pays) In-Network Preventive care: 100% After deductible is met: Office visit: 80% Other: 80% Prescription drugs: 80% Preventive care: 100% After deductible is met: Office visit: 80% Other: 80% Prescription drugs: 80% Preventive care: 100% After deductible is met: Office visit: 80% Other: 80% Prescription drugs: 80% Out-of-Network Most services covered at 60% of reasonable & customary (R&C) charges; prescription drugs are covered at 80% of R&C Most services covered at 60% of reasonable & customary (R&C) charges; prescription drugs are covered at 80% of R&C Most services covered at 60% of reasonable & customary (R&C) charges; prescription drugs are covered at 80% of R&C Annual Coinsurance Maximum: Individual/Family In-Network $1,500/$3,850 $2,200/$5,400 $3,200/$6,450 Out-of-Network $5,600/$11,900 $8,000/$16,600 $10,000/$20,000 Maximum Out-of-Pocket Exposure: Individual/Family (3) Once out-of-pocket limit is reached (separate for in-network and out-of-network), plan pays 100% of the covered expenses for the remainder of the calendar year. In-Network $3,000/$6,850 $4,400/$10,100 $6,400/$12,900 Out-of-Network $11,200/$23,200 $16,000/$32,600 $20,000/$40,000 2 (1) Family deductible must be met for any member in the family to meet deductible requirement.