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Policy cmq4tvf3a000m45t8b2lzrz4r
Platinum Care
Plan year 2026 · Annual deductible $250.00· Out-of-pocket max $2000.00 The most a member pays out-of-pocket per year for covered services — enforced via the OOP accumulator.
$250.00 annual deductible, $2000.00 out-of-pocket max. Cosmetic at 50% coinsurance; Diagnostic lab at 10% coinsurance (up to $3000.00/yr); Mri at 10% coinsurance; Office visit at $10.00 copay (up to $1000.00/yr); Physical therapy at 10% coinsurance (up to $5000.00/yr).
Coverage rules
These rules are stored as data and applied by the adjudication pipeline — every decision on a claim traces back to one of these rows.
| Service | Covered | Cost-share | Deductible | Annual limit | Review |
|---|---|---|---|---|---|
Cosmetic Cosmetic at 50% coinsurance. | 50% coinsurance | — | — | — | |
Diagnostic lab Diagnostic lab at 10% coinsurance (up to $3000.00/yr). | 10% coinsurance | — | $3000.00 | — | |
Mri Mri at 10% coinsurance. | 10% coinsurance | — | — | — | |
Office visit Office visit at $10.00 copay (up to $1000.00/yr). | $10.00 copay | — | $1000.00 | — | |
Physical therapy Physical therapy at 10% coinsurance (up to $5000.00/yr). | 10% coinsurance | — | $5000.00 | — |