Questions and answers about the Coverage Examples: What are some of the assumptions What does a Coverage Example Can I use Coverage Examples to behind the Coverage Examples? show? compare plans? Yes. For each treatment situation, the Coverage When you look at the Summary of Costs don't include premiums. Example helps you see how deductibles, Benefits and Coverage for other plans, copayments, and coinsurance can add up. It Sample care costs are based on national you'll find the same Coverage Examples. also helps you see what expenses might be left averages supplied by the U.S. Department When you compare plans, check the "Patient up to you to pay because the service or of Health and Human Services, and aren't Pays" box in each example. The smaller that treatment isn't covered or payment is limited. specific to a particular geographic area or number, the more coverage the plan health plan. provides. Does the Coverage Example predict The patient's condition was not an excluded or preexisting condition. my own care needs? Are there other costs I should and many other factors. premium you pay. Generally, the lower All services and treatments started and your premium, the more you'll pay in ended in the same coverage period. out-of-pocket costs, such as copayments, Does the Coverage Example predict are no other medical expenses for deductibles, and coinsurance. You should my future expenses? any member covered under this plan. also consider contributions to accounts such No. Out-of-pocket expenses are based only on Coverage Examples are not cost as health savings accounts (HSAs), flexible treating the condition in the example. estimators. You can't use the examples to spending arrangements (FSAs) or health The patient received all care from estimate costs for an actual condition. They reimbursement accounts (HRAs) that help in-network providers. If the patient had are for comparative purposes only. Your you pay out-of-pocket expenses. received care from out-of-network own costs will be different depending on the care you receive, the prices your providers, costs would have been higher. providers charge, and the reimbursement your health plan allows. No. Treatments shown are just examples. The care you would receive consider when comparing for this condition could be different, based on your doctor's advice, your age, how serious your condition is, Yes. An important cost is the
Questions and answers about the Coverage Examples: What are some of the assumptions behind the Coverage Examples? Costs don't include premiums. Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren't specific to a particular geographic area or health plan. What does a Coverage Example show? For each treatment situation, the Coverage Example helps you see how deductibles, copayments, and coinsurance can add up. It also helps you see what expenses might be left up to you to pay because the service or treatment isn't covered or payment is limited. Does the Coverage Example predict Can I use Coverage Examples to compare plans? Yes. When you look at the Summary of Benefits and Coverage for other plans, you'll find the same Coverage Examples. When you compare plans, check the "Patient Pays" box in each example. The smaller that number, the more coverage the plan provides. The patient's condition was not an excluded or preexisting condition. my own care needs? Are there other costs I should All services and treatments started and ended in the same coverage period. are no other medical expenses for any member covered under this plan. Out-of-pocket expenses are based only on treating the condition in the example. The patient received all care from in-network providers. If the patient had received care from out-of-network providers, costs would have been higher. No. Treatments shown are just examples. The care you would receive for this condition could be different, based on your doctor's advice, your age, how serious your condition is, and many other factors. Does the Coverage Example predict my future expenses? No. Coverage Examples are not cost estimators. You can't use the examples to estimate costs for an actual condition. They are for comparative purposes only. Your own costs will be different depending on the care you receive, the prices your providers charge, and the reimbursement your health plan allows. consider when comparing Yes. An important cost is the premium you pay. Generally, the lower your premium, the more you'll pay in out-of-pocket costs, such as copayments, deductibles, and coinsurance. You should also consider contributions to accounts such as health savings accounts (HSAs), flexible spending arrangements (FSAs) or health reimbursement accounts (HRAs) that help you pay out-of-pocket expenses.
SBC%20In%20State%20Plan%20Eff%202016%2001%2001%20FINAL.docx