TCHP Out-of-Pocket Maximum Change

Teachers’ Retirement Insurance Program (TRIP) Benefit Plans

Deductibles and eligible coinsurance payments accumulate toward the annual out-of-pocket maximums for the Teachers’ Choice Health Plan (TCHP) plan. After the out-of-pocket maximum has been met, coinsurance amounts are no longer required and the plan pays 100% of eligible charges for the remainder of the plan year. There are two separate out-of-pocket maximums, one for in-network charges and one for out-of-network charges.

Effective July 1, 2011, all charges for out-of-network services will be applied toward the ‘Out-of-Network’ out-of-pocket maximum and all charges for in-network services will be applied toward the ‘In-Network’ out-of-pocket maximum. Previously, all charges, except those incurred for out-of-network hospital services were applied toward the in-network, out-of-pocket maximum.