Each covered person has a maximum out-patient benefit per calendar year subject to a maximum benefit for all covered persons within a family unit that is equal to two (2) or three (3) times the individual out-patient benefit maximum. This feature is determined by the plan design the employer and the insurance professional choose. This family maximum applies to the entire family unit, regardless of the number of covered persons within the family unit, however, in no event will the maximum calendar year out-patient benefit for any one person exceed the individual maximum. For example, if you have a $2,000 individual Out-Patient Benefit with a 2x family limit and elect dependent coverage, the total out-patient benefit available to the entire family unit is $4,000. Under this scenario, if you accrue $2,500 in eligible outpatient expenses in a calendar year, then the Out-Patient 2 Benefit would cap for you at $2,000 for the calendar year and any out-of-pocket expenses you have above that cap would be your responsibility. Your dependents, though, would still have $2,000 available to them for eligible out-patient expenses which could be applied to charges for one specific dependent or applied to charges incurred by several dependents.
