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2015PROVIDER
MANUAL
North Carolina
South Carolina INT×15×28501 04292015 2015 Ignitable OF CONTENTS
CUSTOMER INFORMATION
Eligibility Verification
2015 ID Cards
Maximum OutofPocket (LOOP)
Customer
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What is maximum out-of-pocket moop?
Maximum out-of-pocket (MOOP) is the most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care, your health plan pays 100% of the costs of covered benefits.
Who is required to file maximum out-of-pocket moop?
Health insurance providers and employers offering health insurance plans are required to provide information on maximum out-of-pocket costs to their members/employees.
How to fill out maximum out-of-pocket moop?
Maximum out-of-pocket costs are automatically calculated by the health insurance provider based on the plan details and the member's utilization of covered services. Members can keep track of their progress towards meeting their MOOP by checking their Explanation of Benefits (EOB) statements.
What is the purpose of maximum out-of-pocket moop?
The purpose of Maximum out-of-pocket (MOOP) is to set a limit on the amount of money a member has to spend on covered services in a plan year, providing financial protection and peace of mind.
What information must be reported on maximum out-of-pocket moop?
Information reported on maximum out-of-pocket (MOOP) includes the total MOOP amount, the breakdown of deductibles, copayments, and coinsurance applied towards the MOOP, as well as any exclusions or limitations.
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