5.3 ANNUAL OUT-OF-POCKET LIMIT

The Annual Out-of-Pocket Limit is the maximum amount of Covered Expenses each Participant pays each calendar year. Once Participants have reached their Annual Out-of-Pocket Limit, Covered Expenses during the remainder of that calendar year are payable at 100%. The calendar year deductible is included in the Annual Out-of-Pocket Limit.
The following expenses are not applied toward the Out-of-Pocket Limit:

• An expense reduced because it is in excess of the Usual, Reasonable and Customary charge;
  
• An expense for a non-covered service; or
  
• Any expenses under Prescription Drug, Hearing Loss, Vision Care, or Dental Care Benefits.
  
• Any expenses for outpatient Mental Health and/or Substance Abuse treatments.

For Eligible Employees and their Dependents

The Annual Out-of-Pocket Limit for each Eligible Employee is $3,000 during a calendar year. The family Annual Out-of-Pocket Limit is $6,000 during a calendar year.

For Retired Participants and their Dependents Without Medicare

The amount of the Annual Out-of-Pocket Limit for each Retired Participant who is not yet eligible for Medicare is $6,000 during a calendar year.

For Retired Participants and their Dependents With Medicare

The Annual Out-of-Pocket Limit for each Retired Participant who has Medicare is $1,500 during a calendar year. If a Retired Participant has Medicare and his or her Spouse does not have Medicare, each will pay their appropriate Annual Out-of-Pocket Limit (in this example, the Participant would have a $1,500 Annual Out-of-Pocket Limit and his or her spouse would have a $6,000 Annual Out-of-Pocket Limit).