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Help for question 4

What is the plan's most common coinsurance among these three services:

1. Primary care visit to treat an injury or illness,

2. Diagnostic test, and

3. Durable medical equipment?

Where to look

You will find all three services listed under "Common Medical Events" and "Services you May Need" on the Summary of Benefits and Coverage.

Only look at amounts for a single person (or individual) using a preferred (or in-network) provider.

Screenshot of example plan with arrows pointing to the primary care visit, diagnostic test, and durable medical equipment co-pay lines

How to answer

If you see

 Answer like this:

The same coinsurance amount for at least two of these services

Examples:

  • One service has a copay, and the other two have the same coinsurance amount
  • All three services have the same coinsurance amount

Fill out Question 4 with the coinsurance amount you see most often.

Different coinsurance amounts, or copays and coinsurance
 
Examples:

  • One service has a copay, and the other two have different coinsurance amounts
  • Two services have copays, and one has coinsurance
  • All three services each have different coinsurance amounts, or copays ($) with coinsurance

Fill out Question 4 with the highest coinsurance amount you see.
Copays for all three services Skip Question 4.
 
Go to Question 5.