Do These Expenses Count Towards The Coinsurance Maximum?
Utilization review penalties
Services not covered by the Plan including all those found in the Medical Limitations and Exclusions section
Prescription drug co-payments
Generic drug differential amounts
Services not considered medically necessary
The private room co-payment
The emergency room co-payment
Individual Prescription Drug Deductible Before the Plan will pay any of the cost for prescription drugs, each participant must first satisfy a $50 prescription drug deductible each calendar year.
The prescription drug deductible and co-payment amounts will not apply toward satisfying the medical calendar year deductible or coinsurance maximum. Prescription drug benefits paid by the Plan will apply toward the participant’s $1,000,000 lifetime maximum.