The Puerto Rico medical plan—the MCS PPO—has no annual deductible, for in-network or out-of-network coverage. However, there is an annual out-of-pocket maximum.
It’s important to understand how the out-of-pocket maximum works when using your plan benefits.
In addition to the details below, keep the following in mind:
- The Puerto Rico medical plan includes coverage for in-network and out-of-network providers.
- Out-of-network charges do not count toward your out-of-pocket maximum. Similarly, in-network charges do not count toward your out-of-network out-of-pocket maximum.
- Your paycheck contributions to purchase health care coverage do not apply toward your out-of-pocket maximum.
How the Out-of-Pocket Maximum Works
The out-of-pocket maximum is the most you have to pay for covered medical services in a year. Generally, it includes any deductible (which doesn’t apply because there is no deductible in the MCS PPO) as well as any copayments and/or coinsurance.
Here’s how the out-of-pocket maximum works if you have family coverage:
- Once a covered family member meets the individual out-of-pocket maximum for the option you select, your insurance will pay the full cost of covered charges for that family member.
- Charges for all covered family members will continue to count toward the family out-of-pocket maximum. Once the family out-of-pocket maximum is met, your insurance will pay the full cost of covered charges for all covered family members.
If you have any questions about the out-of-pocket maximum, contact MCS.