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For catastrophic medical expenses after the G.H.I. basic refund, the DEA requires an out-of-pocket deductible of $4,000 per calendar year. When G.H.I. original Explanation of Benefits (EOB) statements are submitted to the DEA reflecting the deductible, we will refund $3,000 of the deductible. All covered expenses i.e., those claims in which GHI has made some level of payment, after the deductible will be processed at a 100% reimbursement level not to exceed $250,000 lifetime per family. This catastrophic medical benefit applies only to members enrolled in the GHI-CBP program offered through the City of New York Health Benefits office. |