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") individual Deductible or family Deductible must be satisfied each calendar year before any payment for certain services and medications will be made by AvMed for any Claim. The Deductible is accumulated across all levels. Satisfaction of the Deductible under one Benefit Level will count toward satisfaction of the Dednctible under the other Benefit Levels. If two or more covered Members of a family incur injury due to the same accident, the Deductible applies only once for all such expenses. If during a calendar year, the covered Members of a family incur eligible expenses for which no benefits are payable because of the Deductible requirements and the amount of such eligible expense equals the family Deductible limit, then no further Deductible will apply to the covered Members of the family during the remainder of such calendar year. Any eligible expenses credited by AvMed toward your Deductible requirement during the last three months of this Group Plan's prior calendar year, will be reduced to the extent of such application for the next ensuing calendar year. Only those eligible expenses submitted on Claims to AvMed will be credited toward the Deductible. Expenses that are not eligible expenses will not be counted toward the satisfaction of the Deductible. Co-insurance. Once the calendar year Deductible has been met, you arc responsible for paying a percentage of eligible expenses. The coverage percentage, hereinafter called 'Co-insurance' is specified in the Schedule of Benefits. You will be responsible for paying any charges not considered an eligible expense. Annual Out-of-Pocket Maximum Limits. Co-insurance and certain Co-payments you pay for benefits received during any calendar year under this Plan are accumulated toward your annual out-of-pocket maximum limit. Once you meet your individnal or family out-of-pocket maximum limit in any calendar year, the Plan will pay 100% of the contracted rate or Maximum Allowable Payment, as applicable, for all covered services for the remainder of that calendar year. Expenses that do not count toward the annual out-of-pocket maximum limit are expenses related to services not covered by this Point of Service Plan, additional amounts incurred for failure to pre-authorize a service requiring prior authorization, expenses that relate to services that exceed any specific treatment Limitations noted in the Schedule of Benefits, and expenses used to satisfY the individual or family deductible. Lifetime Maximum Benefit. While this Group Plan stays in force, the eligible expenses incurred by a Member are limited to the applicable maximum shown in the Schedule of Benefits. When benefits in snch amount have been paid or are payable under this Plan, all coverage will terminate for the Member. Effect of Prior Coverage. The following provision applies to Members who, on the day before the effective date of this Plan, were covered under prior coverage. Prior coverage means the policyholder's group medical plan that this Group Plan replaced. AvMed will automatically cover any such person under this Group Plan on its effective date, subject to the following provision. Those persons eligible according to the terms of this Group Plan wiIl be covered at the level of benefits of this Group Plan. This includes persons who were covered under a continuation provision of the prior coverage to the extent it was required by state or federal law. This continued coverage under this Group Plan will ternlinate on the date that coverage would have terminated according to the law under the prior coverage, had the prior coverage remained in force. ) .J ) Deduetible Carryover. Any expenses incurred by a Member while covered under the prior coverage will be credited toward satisfaction of the Deductible under this Plan if: . The expenses were incurred during the 90 day period before the effective date of the Group Plan; . The expenses were applied toward satisfaction of the Deductible under the prior coverage during the 90-day period before the effective date of this Group Plan; and . The expenses would be considered eligible expenses under this Group Plan. 23 A V-CHOICE-2009 MP-5320 (10/09)