About these Coverage Having a baby Managing type 2 diabetes Examples: (normal delivery) (routine maintenance of a well-controlled condition) These examples show how this plan might cover Amount owed to providers: $7,540 Amount owed to providers: $5,400   medical care in given situations. Use these Plan pays $ Plan pays $ examples to see, in general, how much financial   Patient pays $ Patient pays $ protection a sample patient might get if they are   covered under different plans. Sample care costs: Sample care costs: See the This is next page not a cost for estimator. important Patient pays: Don’t use these examples to about estimate your actual costs these under this plan. The actual examples. care you receive will be different from these examples, and the cost of that care will also be different. Patient pays:
About these Coverage Examples: These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans. Having a baby (normal delivery)  Amount owed to providers: $7,540  Plan pays $  Patient pays $ Sample care costs: Managing type 2 diabetes (routine maintenance of a well-controlled condition)  Amount owed to providers: $5,400  Plan pays $  Patient pays $ Sample care costs: This is not a cost estimator. Don’t use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different. See the next page for important about these examples. Patient pays: Patient pays:
Model_Notice%20O_PPACA_Summary_Benefits_Coverage_SBC.docx