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8. What is an “Out-of-Pocket Maximum”?
Out-of-pocket maximum is the most you have to pay for covered
services in a plan year. After you spend this amount on deductible
and coinsurance, your health plan pays 100% of the costs of covered
beneits. The out-of-pocket limit doesn’t include your monthly
premiums.
Example: the Smith family has an out-of-pocket maximum of
$12,600; they have a $3,000 deductible and will pay that irst, then
pay coinsurance up to $9,600 for the total out-of-pocket maximum
amount of $12,600.
9. What is the difference between “In-Network” and “Out-of-
Network”?
“In-network” healthcare providers have contracted with the
insurance plan to accept certain negotiated (i.e., discounted) rates. You
will typically pay less with an in-network provider. “Out-of-network”
providers have not agreed to the discounted rates. If you go out of
network, you will pay a higher percentage of your coinsurance, plus
there is no control on what an out-of-network provider charges for a
claim.
10. When will my medical costs be paid at 100%?
Eligible medical costs will be reimbursed at 100% after you fully
satisfy your deductible and meet your out-of-pocket maximums.
11. I understand that the costs employees pay for their health plan
premium are “tax friendly,” what does that mean?
This means your premium deduction is taken from your earnings
before any taxes are deducted. This pre-tax deduction reduces your
total tax obligation. For example, if your premium payment is $150
and your tax bracket is 20%, you will pay $30 less in taxes
($150 × 20% = $30).
12. Can I make changes to my insurance choices during the
calendar year?
Generally, no. In order to change your elections after open enrollment,
you must have a qualifying event. These are events such as marriage,
divorce, birth/adoption of a child, death of a dependent or spouse,
etc. Email AONBeneits@aoncology.com for further information.
American Oncology Network 31
Out-of-pocket maximum is the most you have to pay for covered
services in a plan year. After you spend this amount on deductible
and coinsurance, your health plan pays 100% of the costs of covered
beneits. The out-of-pocket limit doesn’t include your monthly
premiums.
Example: the Smith family has an out-of-pocket maximum of
$12,600; they have a $3,000 deductible and will pay that irst, then
pay coinsurance up to $9,600 for the total out-of-pocket maximum
amount of $12,600.
9. What is the difference between “In-Network” and “Out-of-
Network”?
“In-network” healthcare providers have contracted with the
insurance plan to accept certain negotiated (i.e., discounted) rates. You
will typically pay less with an in-network provider. “Out-of-network”
providers have not agreed to the discounted rates. If you go out of
network, you will pay a higher percentage of your coinsurance, plus
there is no control on what an out-of-network provider charges for a
claim.
10. When will my medical costs be paid at 100%?
Eligible medical costs will be reimbursed at 100% after you fully
satisfy your deductible and meet your out-of-pocket maximums.
11. I understand that the costs employees pay for their health plan
premium are “tax friendly,” what does that mean?
This means your premium deduction is taken from your earnings
before any taxes are deducted. This pre-tax deduction reduces your
total tax obligation. For example, if your premium payment is $150
and your tax bracket is 20%, you will pay $30 less in taxes
($150 × 20% = $30).
12. Can I make changes to my insurance choices during the
calendar year?
Generally, no. In order to change your elections after open enrollment,
you must have a qualifying event. These are events such as marriage,
divorce, birth/adoption of a child, death of a dependent or spouse,
etc. Email AONBeneits@aoncology.com for further information.
American Oncology Network 31
