The Summary of Benefits and Coverage (SBC) document helps you choose a health plan. It shows how you and the plan share the costs for covered health care services.
Important: Information about the cost of this plan, called the premium, will be provided separately.
This is only a summary. For more details about your coverage or to get a copy of the complete terms, visit https://www.dfa.ms.gov/insurance or call 1-800-709-7881.
For definitions of common terms like allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can also view the Glossary at www.cciio.cms.gov.
Important Questions | Answers | Why This Matters |
|---|---|---|
What is the overall deductible? | Network: $1,800/individual; $3,600/family. Out-of-network: $2,300/individual; $4,600/family. | You pay costs up to these amounts before the plan pays. Family deductibles apply collectively. |
Are services covered before meeting the deductible? | Yes. Preventive care and primary care visits in-network are covered before the deductible. | Certain services, like preventive care, are covered before you meet your deductible. |
Are there other deductibles for specific services? | Yes, prescription drugs: $75/individual. No other specific deductibles. | Additional deductibles apply, meaning you pay a set amount for prescription drugs before coverage. |
What is the out-of-pocket limit? | Network: $6,500/individual; $13,000/family. Out-of-network: no limit. | Maximum you pay in a year for covered services. Family limits apply collectively. |
What isn't included in the out-of-pocket limit? | Premiums, balance-billing charges, non-covered services, and penalties for no prior approval. | Although paid by you, these costs don't count towards the out-of-pocket limit. |
Will you pay less if you use a network provider? | Yes. Use network providers to pay less. Full list at the link or call 1-800-294-6307. | Within-network use is cheaper; out-of-network could result in higher costs and balance billing. Verify network use before getting services. |
Do you need a referral to see a specialist? | No. | Enables direct specialist access without additional approval. |