What is a Coverage Maximum?
Your plan has a coverage maximum for this service. A coverage maximum is the highest amount your health insurance plan will pay when you have this service done.
Prices for medical services vary depending on where the service is done. You can choose to go to any facility within the network. If you choose one that charges more than the coverage maximum amount, you will have to pay the difference between the coverage maximum and your provider’s rate. That difference will not count toward your deductible or out-of-pocket maximum. It is in addition to your normal out-of-pocket costs (deductibles and/or coinsurance).
Other services in your plan have coverage maximums as well.
Put My Care Compare to Work for You
My Care Compare is an online tool that compares costs of doctors and places you get health services. You can check costs for many health services like lab work. That makes it easy for you to find a provider whose rates match or are below the coverage maximums, which will save you money.
Watch the Coverage Maximum video to see an example of how the limit works and how My Care Compare can help you be prepared and save.
Provider data last updated on:
3/14/2025
Page last updated on: 1/24/2019
Disclaimer: The PDF may not have the most up to date information. Please use the Provider Directory or member login on the previous page for more accurate results. Always call your provider ahead of your appointment to verify they are in your network.
The information on this Web site and any links are for your information only and does not take the place of, or is intended to be a substitute for professional medical advice, diagnosis or treatment from your doctor. Any services recommended or provided by your doctor may not be covered under the terms of your benefit plan. Eligibility and coverage are subject to the specific terms of your benefit plan.
Please note: Some in-network hospitals may employ hospital-based providers, such as laboratories, anesthesiologists, radiologists and emergency room physicians, who are not in your plan’s network. Hospital-based providers are on-site providers who perform medical services within a hospital or health center setting.
A hospital-based provider who is not in network can charge you more than what we pay and you could be billed for the difference (up to the entire cost of the service). This is called balance billing.
Whenever possible, please contact your provider(s) before making an appointment. Verify the provider participates in your plan’s network, and, if applicable, is accepting new patients. Also, prior to services, discuss any applicable facility fees that you will be charged, and responsible for with your provider.
Always seek care for a life-threatening emergency at the hospital nearest to you, regardless of the network status of the hospital or its hospital-based providers. In emergency situations, we will pay your plan's highest level of benefits on the allowed-amount for services provided. This may still result in balance billing.