![]() ![]() ![]() That is, under Standard Option, you pay just 15% of our $100 allowance ($15). If you have met your deductible, you are only responsible for your coinsurance. Here is an example about coinsurance: You see a Preferred physician who charges $250, but our allowance is $100. Under Standard Option, your share consists only of your deductible and coinsurance or copayment. Because of that, when you use a Preferred provider, your share of the provider’s bill for covered care is limited. These types of providers have agreements with the Local Plan to limit what they bill our members. See the descriptions appearing below for the types of providers available in this Plan. Providers that have agreements with this Plan are Preferred or Participating and will not bill you for any balances that are in excess of our allowance for covered services. Whether or not you have to pay the difference between our allowance and the bill will depend on the type of provider you use. It is possible for a provider’s bill to exceed the plan’s allowance by a significant amount. Often, the provider’s bill is more than a fee-for-service plan’s allowance. ![]() For information about how we determine our Plan allowance, see the definition of Plan allowance in Section 10. Fee-for-service plans arrive at their allowances in different ways, so allowances vary. Our “ Plan allowance” is the amount we use to calculate our payment for certain types of covered services. Differences between our allowance and the bill ![]()
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