Products/Benefit Accumulators
KM
SM
Sarah Martinez
Member ID: M-198472 · DOB: 06/14/1979 · Premier Select HMO Gold · Enrolled Jan 1, 2025
Deductible Met Near OOP Max
Medical DeductibleMet
$500
/ $500 max
$0 remaining · Met on Feb 15, 2025
Out-of-Pocket Maximum79%
$3,940
/ $5,000 max
$1,060 remaining until OOP max
Pharmacy DeductibleIntegrated
$0
/ Integrated
Integrated with medical deductible
Pharmacy OOP SpendYTD
$680
/ Integrated
Counts toward medical OOP max
Per-Service Benefit Limits
Benefit CategoryLimitUsedRemainingStatus
Chiropractic Visits30/year1218Available
Mental Health VisitsUnlimited8Available
Physical Therapy60 visits/year2238Available
Acupuncture20 visits/year191Near Limit
DJ
David Johnson + Family
Member ID: F-209183 · DOB: 03/22/1968 · eKlotho PPO Preferred · Family Plan
Deductible In Progress
Family Deductible41%
$410
/ $1,000 max
$590 remaining to family deductible
Family OOP Maximum18%
$1,820
/ $10,000 max
$8,180 remaining to family OOP max
Individual Deductible (David)Met
$250
/ $250 met
Individual deductible met on Mar 3
Individual Deductible (Spouse)64%
$160
/ $250 max
$90 remaining to individual deductible
Accumulator Reset History
Annual ResetJan 1, 2025Plan Year 2025Automatic
Annual ResetJan 1, 2024Plan Year 2024Automatic
Manual CorrectionFeb 14, 2024AdjustmentBy: K. Mitchell
LR
Linda Rodriguez
Member ID: M-341092 · DOB: 11/30/1952 · MediCare Advantage Plus
OOP Max Met No Cost-Share Remaining
Out-of-Pocket Maximum Reached — $3,400 / $3,400
OOP max met on March 28, 2025. No cost-sharing applies for the remainder of plan year 2025.
OOP MaximumReached
$3,400
/ $3,400 max
Met March 28, 2025 — 9 months remaining
Medical DeductibleMet
$200
/ $200 max
Met January 12, 2025
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