Preferred Provider Benefits:

The Insured is not responsible for any difference between what the Company pays for Allowed Amunts and the amount the provider bills, except for the Insured Person's cost-share obligation as specified in the Schedule of Benefits.

Out-of-Network Provider Benefits:

The Insured is responsible for paying, directly to the Out-of-Network Provider, any difference between the amount the provider bills the insured and the amount the Company pays for Allowed Amounts. 

Out-of-Pocket Maximum:

Out-of-Pocket Maximum means the amount of Covered Medical Expenses that must be paid by the Insured Person before Covered Medical Expenses will be paid at 100% for the remainder of the Policy Year. Not all Policies have an Out-of-Pocket Maximum.

Policy Deductible:

Policy deductible shall mean an amount to be subtracted from the amount or amounts otherwise payable as Covered Medical Expenses before payment of any benefit is made.

Allowed Amount:

Allowed Amount means the maximum amount the insurance company is obligated to pay for Covered Medical Expenses.