Uncovering the Gaps
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Questions and Answers

Which of the following services is NOT covered by the plan?

  • Childbirth/delivery professional services (correct)
  • Home health care
  • Habilitation services
  • Rehabilitation services

    • What is the out-of-pocket cost for children's glasses?

  • Varies depending on the network provider
  • No charge
  • Not covered (correct)
  • Varies depending on the out-of-network provider

    • Which of the following services is generally NOT covered by the plan?

  • Routine eye care for adults (correct)
  • Mental health services
  • Skilled nursing care
  • Emergency room services

    • Does this plan provide Minimum Essential Coverage?

    <p>No</p> Signup and view all the answers

    Which of the following is included in the out-of-pocket limit for this plan?

    <p>All of the above</p> Signup and view all the answers

    If you use an out-of-network provider, what might happen?

    <p>You might receive a bill for the difference between the provider's charge and what your plan pays</p> Signup and view all the answers

    Do you need a referral to see a specialist in this plan?

    <p>No</p> Signup and view all the answers

    What is the cost for a specialist visit with a network provider?

    <p>$50/visit</p> Signup and view all the answers

    According to the Summary of Benefits and Coverage, what is the overall deductible for the Advanced MEC plan?

    <p>$0</p> Signup and view all the answers

    Are there services covered before you meet your deductible for the Advanced MEC plan?

    <p>Yes, all covered health services are covered without a deductible.</p> Signup and view all the answers

    Are there any other deductibles for specific services under the Advanced MEC plan?

    <p>No, there are no deductibles for specific services.</p> Signup and view all the answers

    Which of the following types of coverage is generally considered Minimum Essential Coverage?

    <p>Employer-sponsored health insurance</p> Signup and view all the answers

    If a plan does not meet the Minimum Value Standards, what may an individual be eligible for?

    <p>A premium tax credit</p> Signup and view all the answers

    What is the overall deductible for Peg's pregnancy and delivery example event?

    <p>$0</p> Signup and view all the answers

    What is the total amount Joe would pay for cost sharing in his example event of managing Type 2 Diabetes?

    <p>$800</p> Signup and view all the answers

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