I have exceeded the annual calendar year deductible limit, why are my claim(s) still not fully reimbursed?

After satisfying the annual deductible limit, before you receive full reimbursement for expenses, you must continue to pay a certain percentage for your claim(s) up to the reimbursement level (also known as co-insurance).  Once your claims have exceeded the reimbursement level in the calendar year your claims will be reimbursed according to the level of eligibility for expenses

For example, claims will be reimbursed at 80% up to $1,000 in a calendar year and you will be responsible for the other 20%.  Any claims submitted after your claims exceed the $1,000 eligibility limit will be reimbursed at 100%

For more information on reimbursement levels, please refer to your Benefits Booklet by visiting Your Benefits.

For more information on how the deductible affects your claims, visit PBC Deductibles.

Deductibles and reimbursement levels help with plan sustainability.