Copayments and Benefit Percentages
The ROP pays 70% of Eligible Expenses after you satisfy the annual deductible.
Coinsurance (percentage coverage) does not begin until after the annual deductible has been met. The percentages for reimbursement are listed on the Summary of ROP Benefits. Eligible Expenses will be reimbursed based on negotiated rates for network providers and Customary and Reasonable Charges for non-network providers, after meeting the annual deductible. If your non-network provider bills an amount above the Customary and Reasonable Charges (Eligible Expenses), you will be responsible for paying this difference along with your coinsurance. Network providers have agreed not to charge you more than the negotiated rate and you will not be responsible for any amount in excess of the negotiated rate for Covered Health Services. Medicare-eligible members may seek eligible care from non-network providers who accept Medicare's reimbursement rates without being financially disadvantaged by Customary and Reasonable Charges.