Out-of-Pocket Maximum - Iowa Select

The Iowa Select Plan provides an annual maximum limit for the out-of-pocket expenses for both individuals and families.

In 2017, the OPM for the individual's expenses is $1000 and the OPM for Family contracts is $2000. In 2016, the OPM for the individual's expenses is $650 and the OPM for Family contracts is $1450. This does not include prescription medication – there is a separate OPM for prescription medication.

When the amount paid 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 deductibles and the percentage portion of charges are cumulated when determining the annual OPM expense. However, co-payments are not counted in determining when the OPM has been exceeded.

In 2016 and 2017, the annual OPM for prescription drugs is $500 for a Single contract and $1000 for the Family contract. This provision can save you money if you have maintenance medications.