Out-of-Pocket Maximums - Program 3 Plus

Program 3 Plus has an annual maximum limit for the OPM expense for both individuals and families. In 2017, the annual OPM is $1000 for a Single contract and $2000 for the Family contract. In 2016, the annual OPM is $650 for a Single contract and $1450 for the Family contract. 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.