The UIGRADCare 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 $1,000. The OPM for all other contracts is $1,700.
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 deductibles and as the 10% portion of charges are cumulated when determining the annual OPM expense. Co-payments do not apply toward meeting the OPM and continue once the OPM is met.