2015 Dean Health Plan Group Plan book

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10 | Group Insurance Plan Book
Annual and Lifetime Limits Removed on Essential Health Benefits
Essential Health Benefits cannot be subject to dollar limits, either annually or on a lifetime basis. Depending on the
type of plan you purchased, services associated with Essential Health Benefits may still require cost sharing in the
form of copays, coinsurance and deductibles.
Pre-existing Conditions
Your plan will not contain exclusions or limitations for any pre-existing conditions, which are health issues you
experienced before you purchased insurance. In addition, your health insurance premiums will not be higher because
of any pre-existing conditions.
Cost-sharing Maximums
Your plan includes a maximum for the out-of-pocket expenses (the deductible, coinsurance and copay amounts) you
have to pay for health care each year. After you have paid the maximum, your health insurance plan begins to pay 100
percent of the cost of covered services. For 2015, a plan’s maximum for in-network services cannot exceed $6,600
per year for single coverage and $13,200 per year for family coverage. Some plans may have a lower maximum, so be
sure to take a look at the plan’s maximum out-of-pocket level (as well as deductible, coinsurance and copays) when
selecting a plan. Cost-sharing maximums apply to Small Group and Large Group plans in 2015.
Questions?
Call the Customer Care Center*
(800) 279-1301 or visit
*Customer Care Center hours:
Monday through Thursday: 7:30 a.m. to 5 p.m.
Friday 8 a.m. to 4:30 p.m.
Understanding What You Pay
Your Dean Health Plan certificate may use a system of cost-sharing that can include
copayment, deductibles or coinsurance, or any combination of the three. Cost-sharing
is used by most health plans and, put simply, is the amount that you are responsible for
paying after getting covered medical care. Cost-sharing helps keep monthly premiums
low and adds flexibility to health plans. Be sure to check your certificate to understand
which of these cost-sharing components may apply to your coverage.
If you have to pay after you use your health plan for a covered service, you will be
mailed an explanation of benefits (EOB). The EOB details the charges and your financial
responsibility due to any cost sharing. An EOB is not a bill; it’s a breakdown of the
services you used, the amount charged by the provider you saw, and the amount for
which you are financially responsible.
Cost-sharing terms
Please see page 13 for terms and definitions.