The LM HealthWorks Plan has a lot to offer you and your family. Learn how to make the most of its benefits and resources.

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Example of Catastrophic Claim

How costs are shared.
Coverage: Employee only
Cost of care: $15,000
Provider: In network
HealthFund balance: $250

Plan feature What LMC Pays
(percentage)
What you pay
(percentage)
What you pay
(dollar amount)
Annual deductible
(first $650)
0% 100% $650
-$250
(Your HealthFund balance)

$400
HealthFund offsets $250 of annual deductible; you pay remaining $400 to meet deductible. Once deductible is met, you and the plan share remaining cost ($15,000 - $650 = $14,350).
Coinsurance
(next $10,000)
85% 15% $1,500
After the deductible, the plan pays 85% BUT your share is capped by the coinsurance limit -- $1,500.
Claim $$ above employee coinsurance limit
(next $4,350)
100% 0% $0
Once you reach the coinsurance limit, the plan pays covered expenses at 100% for the rest of the calendar year.

Plan pays: $12,850
HealthFund pays: $250
Your share: (deductible plus coinsurance): $1,900

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