AACC_OpenEnrollmentGuide2017

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Having a baby
(normal delivery)
Managing type 2 diabetes
(routine maintenance of
a well-controlled condition)
About these CoverageExamples:These examples show how this plan might covermedical care in given situations. Use theseexamples to see, in general, how much financialprotection a sample patient might get if they arecovered under different plans.
n
Amount owed to providers:
$7,540
n
Plan pays
$6,910
n
Patient pays
$630
Sample care costs:Hospital charges (mother)
$2,700
Routine obstetric care
$2,100
Hospital charges (baby)
$900
Anesthesia
$900
Laboratory tests
$500
Prescriptions
$200
Radiology
$200
Vaccines, other preventive
$40
Total
$7,540
Patient pays:Deductibles
$250
Co-pays
$10
Co-insurance
$220
Limits or exclusions
$150
Total
$630
n
Amount owed to providers:
$5,400
n
Plan pays
$4,660
n
Patient pays
$740
Sample care costs:Prescriptions
$2,900
Medical Equipment and Supplies
$1,300
Office Visits and Procedures
$700
Education
$300
Laboratory tests
$100
Vaccines, other preventive
$100
Total
$5,400
Patient pays:Deductibles
$250
Copays
$350
Coinsurance
$60
Limits or exclusions
$80
Total
$740
This isnot a costestimator.
Don’t use these examples toestimate your actual costsunder this plan. The actualcare you receive will bedifferent from theseexamples, and the cost ofthat care will also bedifferent.See the next page forimportant information aboutthese examples.Note: These coverageexamples calculations arebased on Individual CoverageTier numbers for this plan.
Questions:
If you are a member please call the number on your ID card or by logging into My Account. Otherwise, please call 1-800-628-8549.
If you aren’t
clear about any of the underlined terms used in this form, see the Glossary at
www.carefirst.com/sbcg
.
CareFirst SBC ID: SBC20160816AnneArundelCountyGovernmentPOSN012017 Questions and answersabout the CoverageExamples:What are some of theassumptions behind theCoverage Examples?•
Costs don’t include
premiums
.
•
Sample care costs are based on nationalaverages supplied by the U.S. Departmentof Health and Human Services, and aren’tspecific to a particular geographic area orhealth plan.
•
The patient’s
condition was not an excluded
or preexisting condition.
•
All services and treatments started andended in the same coverage period.
•
There are no other medical expenses forany member covered under this plan.
•
Out-of-pocket expenses are based only ontreating the condition in the example.
•
The patient received all care from in-network
providers
. If the patient had
received care from out-of-networkproviders
, costs would have been higher.
What does a Coverage Exampleshow?For each treatment situation, the CoverageExample helps you see how
deductibles
,co-
payments
, and
co-insurance
can add up. It
also helps you see what expenses might be leftup to you to pay because the service ortreatment isn’t covered or payment is limited.Does the Coverage Examplepredict my own care needs?û
No.
Treatments shown are just examples.
The care you would receive for thiscondition could be different based on yourdoctor’s advice, your age, how serious yourcondition is, and many other factors.
Does the Coverage Examplepredict my future expenses?û
No.
Coverage Examples are
not
cost
estimators. You can’t use the examples toestimate costs for an actual condition. Theyare for comparative purposes only. Yourown costs will be different depending on thecare you receive, the prices your
providers
charge, and the reimbursement your healthplan allows.
Can I use Coverage Examples tocompare plans?
ü
Yes.
When you look at the Summary of
Benefits and Coverage for other plans, you’llfind the same Coverage Examples. Whenyou compare plans, check the “Patient Pays”box in each example. The smaller thatnumber, the more coverage the planprovides.
Are there other costs I shouldconsider when comparingplans?ü
Yes.
An important cost is the
premium
you pay. Generally, the lower yourpremium
, the more you’ll pay in out-of-
pocket costs, such as
co-payments
,
deductibles
, and
co-insurance
. You
should also consider contributions toaccounts such as health savings accounts(HSAs), flexible spending arrangements(FSAs) or health reimbursement accounts(HRAs) that help you pay out-of-pocketexpenses.