SAG-AFTRA Health SPD

Comprehensive Out-of-pocket Maximum

Comprehensive Out-of-pocket Maximum

Plan I

$7,150 per person;
$14,300 per family

No maximum

Plan II

$7,150 per person;
$14,300 per family

No maximum

The comprehensive out-of-pocket maximum is the maximum amount you could pay in any calendar year — including all Copays, Coinsurance and Deductibles — for Hospital, medical, prescription drugs, mental health and substance abuse services from In-network Providers under the Plan. There is no comprehensive out-of-pocket maximum for out-of-network care. The Plan's comprehensive out-of-pocket maximum is set in accordance with the Affordable Care Act (ACA) and updated annually.

If your eligibility changes from Plan I to Plan II during a calendar year, any charges that applied toward your comprehensive out-of-pocket maximum under Plan I will apply toward your Plan II comprehensive out-of-pocket maximum. If your eligibility changes from Plan II to Plan I during a calendar year, the reverse is also true.