Deductible and Out-Of-Pocket Maximum Details The deductible and out-of-pocket maximum are subject to a “cost of living” increase on a yearly basis. This increase is tied to the Consumer Price Index and/or may result from adjustments needed to keep plans within the range for a given metal level; metal levels (e.g., Gold, Silver, Bronze) must always be in compliance with the Affordable Care Act (ACA) for Qualified Health Plans (QHPs). The Marketplace and Cost Share Reduction Plans You may be able to receive help paying your health insurance premium or qualify for plans with reduced deductibles and copays. Plans with reduced deductibles and copays are called Cost Share Reduction (CSR) plans. You can get this assistance if you get health insurance through the Health Insurance Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category. Reduced cost sharing is not available with a Catastrophic plan. If you’re a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits. To see if you’re eligible, please visit healthcare.gov .
Receiving Care Outside Your Network Unless it's an emergency, there is no coverage if you visit a provider that is not in your network. This means you'll be responsible for the full cost of any care or supplies. Emergency care received from an out-of-network provider may result in balance billing from that provider. Please see a policy on Medica.com/Plans4MO for details. Complex Specialty Care Program Receive care for transplants, certain rare cancers and other complex specialty care at Mayo Clinic. For transplants, an allowance for transportation, lodging and living expenses also included. Before you use the program, you need a referral from your network doctor and approval from Medica. Medica Privacy Notice Medica takes its responsibility of protecting your personal information seriously. Where possible, Medica de-identifies or encrypts personal information. We use and disclose personal information only to the extent necessary to conduct treatment, payment and health care operations, or to comply with legal, regulatory or accreditation requirements. Medica’s full Privacy Notice is available upon request by calling (855) 347-5001 (TTY: 711 ) or by going to Medica.com/Privacy .
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