Common use of Cost Sharing Arrangements Clause in Contracts

Cost Sharing Arrangements. The fully insured, ACA compliant group health insurance plan for the US citizens and dual national employees of the Italian Government and their dependents that work and live in the US must be a PPO plan with a national provider network and must include the following covered services and cost sharing arrangements: Annual Deductibles: There will be no In Network Deductible. The Out of Network Deductible will be $1,000 for single only coverage and $2,000 for any non-single coverage tier. Out-of-Pocket Maximums: In Network Out-of-Pocket Maximum will be $2,000 for single only coverage and $4,000 for any non-single coverage tier. Out of Network Out-of-Pocket Maximum will be $4,000 for single only coverage and $8,000 for any non-single coverage tier. All covered medical and prescription drug services must accumulate towards the Out-of-Pocket Maximum. The In Network and Out of Network Out-of-Pocket Maximums will not cross accumulate. Annual and Lifetime Maximum Benefit Limits: There will be no annual or lifetime maximum benefit limits for any covered medical or prescription drug service, either In Network or Out of Network. Preventive Services: In Network preventive services, as defined by the US Preventive Services Task Force (USPSTF) including but not limited to mandatory vaccinations for children, well woman visits, well child visits, annual adult physical examinations, and routine cancer screenings (including but not limited to breast cancer screening, Pap test, prostate cancer screening, and colorectal cancer screenings), will be covered at no cost to the member. The coinsurance for Out of Network preventive services will be 20% of the allowed benefit, after the Out of Network annual deductible.