Your annual medical out-of-pocket maximum is a limit on the amount you need to pay for covered medical services within a benefit year. All Tufts Health Direct members have an annual out-of-pocket maximum. Your annual deductibles (if applicable), medical coinsurance and medical copayments all contribute to this maximum amount.
Once you reach your full annual medical out-of-pocket maximum, we will pay for covered services for the remainder of the benefit year, and you no longer need to pay copayments or coinsurance for covered medical services. Keep in mind: Once you reach your full annual medical out-of-pocket maximum, you are still responsible for your monthly premiums.
If you have a family plan and a medical out-of-pocket maximum, your family out-of-pocket maximum combines the annual deductibles, medical coinsurance and medical copayments 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 your family plan will need to pay for covered medical services for the rest of the benefit year. Keep in mind: Once you reach your full family annual medical out-of-pocket maximum, you are still responsible for your monthly premiums.