The Out-of-Hospital Expenses Benefit ("OHEB") simplified

• Libcare pays your qualifying day to day claims from the Medical Savings Facility first.
• When you use up your Medical Savings Facility, Libcare pays further qualifying claims from your annual Out-of-Hospital Expenses Benefit next.
• If you run out of both your Medical Savings Facility and your Out-of-Hospital Expenses Benefit, you pay any further claims from your own pocket. This is the Self-Payment Gap.
• For all claims processed from the Medical Savings Facility and Out-of Hospital Expenses Benefit, Libcare pays and accumulates claims to the Threshold Level at the lower of cost or the Libcare Rate.
• For self-paid claims that are submitted to Libcare applicable to the Self-Payment Gap, these also accumulate to the Threshold Level at the lower of the cost or the Libcare Rate. If any claims are charged above the Libcare Rate, the excess above the Libcare Rate does not accumulate to the Threshold Level.
• If the total amount of qualifying self-paid claims reaches the Threshold Level value, Libcare will again provide funding for further qualifying claims, up to your remaining available benefits in each category in the various Threshold Benefits, at the lower of the cost or the Libcare Rate.
• See the Libcare Member Guide (page 28) for more details on how your Libcare benefits work.