How the Maroon Plan Works

How It Works

Out-of-Pocket Maximum

An out-of-pocket maximum is a cap on how much you have to pay for your family’s covered medical expenses in a calendar year. After you reach the out-of-pocket maximum, the plan pays 100% of all remaining covered expenses for that year.

The individual and family Deductible is counted toward the out-of-pocket maximum.

For Example

Mark works at the University and enrolls himself and his wife in the Maroon Plan. He earns $31,000, so his Out-of-Pocket Limit is $2,000 a year. By October, Mark has paid $800 in the Deductible and Coinsurance, and his wife has paid $1,200. Because they have reached the Out-of-Pocket Limit of $2,000 for the year ($800 + $1,200 = $2,000), their covered expenses for the rest of the calendar year will be paid in full.

The out-of-pocket maximum does not include:

The $200 Deductible for each admission to an out-of-network Hospital.

Expenses that are not covered by the plan.

Any extra costs incurred for not following procedures.

Charges over the maximums allowed by the plan.

Outpatient mental health services over the maximum amount allowed under the plan.

Amounts above the eligible or allowable charges.

Wellness services beyond the $300 payable under the plan.

Prescription drug Copayments.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.