Deductibles and Maximums
Deductibles
The annual deductible is $400 per person, up to a family maximum of $1,200.
Charges for non-covered services, penalties for not obtaining authorization and amounts over Customary and Reasonable do not apply toward the annual deductible.
Plan Maximums
Out-of-Pocket Maximums
Under the ROP, the most you will have to pay for Eligible Expenses for any single member of your family each year is $4,000 — the ROP's annual out-of-pocket maximum. If the $400 deductible plus your 30% share of Eligible Expenses for Covered Health Services reach $4,000, the ROP will pay 100% of all Eligible Expenses for that family member for the rest of the calendar year. If your entire family's out-of-pocket expenses reach $8,000 during the year, the ROP will pay 100% of your family's Eligible Expenses for the rest of the calendar year. Charges for non-covered services, charges above Customary and Reasonable, and penalties for not obtaining authorization do not apply toward your annual out-of-pocket maximum.
Lifetime Maximums
The Plan does not have an overall lifetime maximum benefit, but there are lifetime maximums for the following services or supplies:
Service or Supply
Lifetime Maximum
Infertility Treatments
$7,000 combined for all Anthem Blue Cross-administered plans or prior claims administrators.
Reimbursement for Travel and Lodging Expenses incurred in connection with Organ Transplants
Transportation and lodging expenses for the transplant recipient and companion(s)
$10,000 combined for all travel expenses (IRS limit).
Reimbursement for Travel and Lodging Expenses incurred in connection with Bariatric/Transgender Surgery
$3,000 combined for all travel expenses.