Charter Communications, LLC
Medical and Drug
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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.