The Blue Access Plan provides an annual maximum limit for the out-of-pocket maximum (OPM) expense for both individuals and families. The OPM for an individual's expenses is $750 and for Family contracts is $1,500.
When the amount paid by the insured equals the applicable OPM, the plan pays 100% of the charges for most additional medically necessary expenses incurred during the remainder of the calendar year.
Amounts an insured pays as coinsurance and copayments are acumulated and determine the annual OPM expense.
Beginning in 2016, the annual Pharmacy OPM of $5850 for single contracts and $11,700 for family contracts will apply.