Claims & Accounts
Other Claims
Member Actions
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Account Balances
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Account Balances |
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* Includes $100 rolled over from prior plan year.
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Benefit Amount Tracking |
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 |
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| Description |
 |
Beginning Amount |
 |
Applied Amount |
 |
Remaining Amount |
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| Deductible |
|
|
|
| |
Chris |
(In Network) |
$300.00 |
$0.00 |
$300.00 |
| |
|
(Out of Network) |
$500.00 |
$0.00 |
$500.00 |
|
 |
| |
Pat |
(In Network) |
$300.00 |
$300.00 |
$0.00 |
| |
|
(Out of Network) |
$500.00 |
$300.00 |
$200.00 |
|
 |
| |
Madison |
(In Network) |
$300.00 |
$150.00 |
$150.00 |
| |
|
(Out of Network) |
$500.00 |
$150.00 |
$350.00 |
|
 |
| |
Family |
(In Network) |
$600.00 |
$450.00 |
$150.00 |
| |
|
(Out of Network) |
$1,000.00 |
$450.00 |
$550.00 |
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| Out of Pocket Maximum |
|
|
|
| |
Chris |
(In Network) |
$500.00 |
$0.00 |
$500 |
| |
|
(Out of Network) |
$1,500.00 |
$0.00 |
$1,500 |
|
 |
| |
Pat |
(In Network) |
$500.00 |
$417.80 |
$82.20 |
| |
|
(Out of Network) |
$1,500.00 |
$417.80 |
$1,082.20 |
|
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| |
Madison |
(In Network) |
$500.00 |
$150.00 |
$350 |
| |
|
(Out of Network) |
$1,500.00 |
$150.00 |
$1,350 |
|
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| |
Family |
(In Network) |
$1,000.00 |
$567.80 |
$1432.20 |
| |
|
(Out of Network) |
$3,000.00 |
$567.80 |
$3432.20 |
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| Lifetime Maximum |
$5,000,000.00 |
$12,486.40 |
$4,987,513.60 |
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