We’ve made it simple to find your maximum-out-of-pocket limits. Just sign into your account and select “Coverage & Benefits” from the top navigation menu. If you don’t have an established account, it’s easy to create an account to access these features.
Most OhioHealthy plans limit the amount of money you would pay in copayments, coinsurance, and deductibles. This maximum-out-of-pocket amount limits the total amount you and any dependents would be required to pay in a given plan year. Your specific maximum amount is determined by your plan benefits and can be found on your Schedule of Benefits or your Summary of Benefits & Coverage.
Once you have reached your maximum out-of-pocket amount, no further payments will be required from you for the remainder of the plan year, except for any services that do not apply toward this amount.
For instance, depending on your health plan, the copayments, coinsurance and deductibles you pay for many services count toward your maximum out-of-pocket amount (NOTE: your specific plan may have separate maximum amounts for in-network services and out-of-network services). However, some out-of-pocket expenses do NOT count toward your maximum amount. A list of those health services can be found on your Schedule of Benefits. For such services, you will still have copayments, coinsurance and deductibles due even after you have reached your maximum out-of-pocket obligation.
If you have any questions at all or believe you are entitled to a refund for an overpayment against your maximum amount, please contact a Member Advocate at the number on the back of your member ID card.