All members Submit a claim
Priya Sharma
Enrolled in Standard PPO · Plan year 2026
Standard PPO
View full policy →$1000.00 annual deductible, $5000.00 out-of-pocket max. Cosmetic isn't covered; Diagnostic lab at 20% coinsurance (after deductible); Mri at 20% coinsurance (after deductible, needs review); Office visit at $30.00 copay; Physical therapy at 20% coinsurance (up to $2000.00/yr).
Benefits used
Deductible The member pays toward this each year before the plan starts paying for deductible-eligible services.$1000.00 / $1000.00
Fully used — further charges to this benefit aren’t covered.
Out-of-pocket max The most the member pays per year for covered services (deductible + copays + coinsurance). Once reached, the plan pays 100% of further covered costs.$250.00 / $5000.00
Physical therapy — annual limit The plan covers this benefit up to a yearly cap; amounts above the cap are the member’s responsibility.$2000.00 / $2000.00
Fully used — further charges to this benefit aren’t covered.
Adjust usage
Set how much of the deductible and each capped benefit this member has already used, then submit a claim to watch the deductible finish or a limit exhaust. This is the only thing editable here — coverage rules belong to the policy.
Claims
| CLM-500 | June 8, 2026 | Under reviewAwaiting a manual decision before payment. | $400.00 |