Your employee's annual medical out-of-pocket maximum is a limit on the amount they need to pay for covered medical services within a benefit year. All Tufts Health Direct members have an annual out-of-pocket maximum. Your employee's annual deductibles (if applicable), medical co-insurance, and medical co-payments all contribute to this maximum amount.
Once your employee reaches their full annual medical out-of-pocket maximum, we will pay for covered services for the remainder of the benefit year and they no longer need to pay co-payments or co-insurance for covered medical services. Keep in mind, once your employee reaches their full annual medical out-of-pocket maximum, they are still responsible for their monthly premiums.
If your employee has a family plan, and a medical out-of-pocket maximum, their family out-of-pocket maximum combines the annual deductibles, medical co-insurance, and medical co-payments paid by covered family members. For all members enrolled under a family plan, once the family reaches the full annual medical family out-of-pocket maximum no one in their family plan will need to pay for covered medical services for the rest of the benefit year. Keep in mind, once your employee reaches their full family annual medical out-of-pocket maximum, they are still responsible for their monthly premium.