Take charge: Out-of-pocket maximums
When you use your Asante Health Plan, you share the cost of care with the plan when you pay your deductible, your copays and your coinsurance. But did you know that there’s a limit to how much you’ll pay over the calendar year? That amount is called an out-of-pocket maximum.
Each Asante Health Plan medical option has a dollar amount listed for the out-of-pocket maximum. When you use medical services, the amount that you pay toward your deductible, copays and coinsurance all go toward that maximum, and once you reach it, your plan pays 100% of allowed charges for the rest of that calendar year. The amount taken from your paycheck for the cost of the plan, however, does not go toward the maximum.
Based on the Asante Health Plan option you choose, you may have an individual out-of-pocket maximum and one for the family. In this case, when the deductible, copays and coinsurance for one person reaches the individual max, the plan would pay 100% of allowed charges for that person. When what is paid reaches the family maximum, the plan would pay 100% of allowed charges for everyone on the plan.
If your plan’s individual out-of-pocket maximum is, say, a hypothetical amount of $1,500, once you have paid out $1,500 for health care services, the plan covers 100% of charges for the rest of the year. If the same plan has a hypothetical family out-of-pocket maximum of $3,000, and two people on the plan had each paid $1,500 for services, the plan would then pay 100% of the charges for them and anybody else on the plan. Maximums may be different, depending on the plan option you choose.
If you or your family face a year with high medical expenses, it can be comforting to know that you won’t necessarily be responsible for the full charges.
You can find more information on the Asante Health Plan options on myHR or Asante.org.
If you have any questions, please email the Asante Benefits department or call (541) 789-4551. You can also submit a case in the Ask HR section of myHR.