It’s accurate, but I’ll clarify my previous language a little. The plan pays 100% after the deductible is met, except for mental healthcare, that pays 90% after the deductible, assuming in-network. So while the plan language doesn’t say the max out of pocket doesn’t apply to non-mental healthcare, since they are paying 100% for in-network after the deductible that’s how it works out. So in a catastrophic year you wouldn’t need to meet the $1000/$3000 to get 100% paid by the insurance, rather just the $250/$750 deductibles.

Where the $1000/$3000 max out of pocket does come into play for non-mental healthcare costs, when you add up all your costs, deductible, office copays, emergency room copays and Rx copays, if those all add up to $1000 for one family member or $3000 for the family, in theory you should pay nothing for the remainder of the year. No more copays for office visits or Rx. I say in theory because I’ve never hit it, but have come close to the $1000 individual in various years.

I’ll reiterate, the Diamond plan is a great plan that most should be on. There are some very unique situations, like mine, that the plan B is better and I hope the others like me were on it when we signed the new CBA. For new people, or those who come into new situations that would have benefited from the plan B, it’s unfortunate you can’t get in it. At the end of the day the costs between the 2 plans is anywhere from $1200-$1700 different (excluding mental health related issues) and that number is getting smaller every year as the annual premium increases have a larger effect on the plan B’s higher premiums than on the lower premiums of the Diamond plan. I haven’t done the math on the out years, but eventually the plan B will become obsolete in nearly all situations, barring a very rare situation of course.