Deductibles
The annual deductible is the amount you must pay before the Plan starts paying for benefits.
 
Network
Non-Network
One Person
$120
$240
Two People
$240
$480
Three or More People
$320
$680
Charges for non-covered services, penalties for not obtaining authorization, amounts over Customary and Reasonable, and flat dollar copayments (for example, for doctor's office visits, emergency room visits, or hospital admissions) do not apply toward the annual deductible.
Examples of How Copayments Work With the Annual Deductible
(Assuming NAP Member Uses Network Providers for All Three Office Visits)
Visit #1 To Primary Care Physician: Provider charges $100 for the office visit. The claim will be paid as follows:
Network Provider
Total Billed
$100
Amount Allowed For a PPO network participating provider (based on the negotiated discount)
$75
Primary Care Physician Office Visit Copay
$10
Amount Applied to Calendar Year Deductible
$65
Calendar Year Deductible Remaining To be Met
$55
Amount Paid by the Plan
$0
Total Member Responsibility for this Visit
$75
Visit #2 To OB/GYN Specialist: Provider charges $150 for the office visit. The claim will be paid as follows:
Network Provider
Total Billed
$150
Amount Allowed For a PPO network participating provider (based on the negotiated discount)
$100
Specialist Office Visit Copay
$20
Allowed Amount Remaining After Copay
$80
Amount Applied to Remaining Calendar Year Deductible which is Now Met
$55
Amount Paid by the Plan
$25
Total Member Responsibility for this Visit
$75
Visit #3 To Dermatology Specialist: Provider charges $165 for the office visit. The claim will be paid as follows:
Network Provider
Total Billed
$165
Amount Allowed For a PPO network participating provider (based on the negotiated discount)
$125
Specialist Office Visit Copay
$20
Allowed Amount Remaining After Copay
$105
Amount Paid by the Plan
$105
Total Member Responsibility for this Visit
$20