Copayments/Deductibles
Use this table to enter any copayments, deductibles, or out-of-pocket amounts that are required for this benefit plan. These fields are for information only and this table is optional.
Contents
| Field | Description |
|---|---|
| Copay/Deductible Type | Enter up to 15 alphanumeric characters to uniquely identify the type of copayment or deductible. For example, you might specify a copayment for an expense that is In the Network or one that is Out of Network. |
| Office Visit Copay | Enter the copay amount this benefit plan requires for an office visit. |
| Specialist Visit Copay | Enter the copay amount this benefit plan requires for a specialist visit. |
| Preventive Care Copay | Enter the copay amount this benefit plan requires for a preventive care visit. |
| Brand Prescriptions | Enter the copay amount this benefit plan requires for a brand prescription. |
| Generic Prescriptions | Enter the copay amount this benefit plan requires for a generic prescription. |
| Individual Deductible | Enter the annual deductible amount this benefit plan requires for an individual. You can enter an amount as large as $9,999,999,999.00. |
| Family Deductible | Enter the annual deductible amount this benefit plan requires for a family. |
| Employee Pmnt After Deductible | Enter for the percentage (not to exceed 100.00%) the employee must pay for medical expenses incurred after the annual deductible has been met. |
| Indiv Max Out of Pocket | Enter the maximum annual amount this benefit plan requires an individual to pay "out-of-pocket." |
| Family Max Out of Pocket | Enter the maximum annual amount this benefit plan requires a family to pay "out-of-pocket." |
| Comments | Enter any additional comments about this benefit plan. |