Charter Communications, LLC: Medical and Drug

Deductible

The amount of Covered Expenses the Participant or group of Covered Family Members must incur before Medical Benefits are payable. It applies each Calendar Year. Covered Expenses incurred in, and applied toward, the Deductible in the last three (3) months of the Calendar Year by a Participant and Dependents will be applied toward the Deductible for the next Calendar Year.

Coverage Amount
Individual Deductible $50
Family Deductible $150
Non-Notification Deductible (does not count toward the out-of-pocket feature, and penalty is capped, in the aggregate, at $1000 per year) $200
Non-Network Hospital Confinement Deductible (limited to first confinement) $200

Out-of-Pocket Maximum

The amount of Covered Expenses the Participant or group of Covered Family Members must incur before Medical Benefits are payable. It applies each Calendar Year. Covered Expenses incurred in, and applied toward, the Deductible in the last three (3) months of the Calendar Year by a Participant and Dependents will be applied toward the Deductible for the next Calendar Year.

Coverage Amount
Individual Medical out-of-pocket Maximum (excluding Alcoholism/Chemical Dependency treatment expenses) $1,000
Individual Medical out-of-pocket Maximum (excluding Alcoholism/Chemical Dependency treatment expenses) $2,000
Family Medical out-of-pocket Maximum (excluding Alcoholism/Chemical Dependency treatment expenses) $2,000
Family Medical out-of-pocket Maximum (excluding Alcoholism/Chemical Dependency treatment expenses) $4,000
Prescription Drug out-of-pocket Maximum None

Please refer to your Summary Plan Description (SPD) for additional information. In the case of a discrepancy between this website and the language contained within the SPD, the latter will take precedence.