Before completing an enrollment application, which items must an agent review with the consumer?

• A. The agent's personal health history.
• B. The consumer's preferred pharmacy only.
• C. The plan's network characteristics and how using out-of-network providers may impact coverage and costs, covered benefits and limitations, and plan related costs such as monthly premium and copayments/coinsurance for services received.
• D. The current market trends in overall healthcare costs.

Answer: (C)

Understanding plan specifics and costs is essential before enrolling. The agent should walk the consumer through the plan’s network characteristics and explain how using out-of-network providers may affect coverage and costs, along with the plan’s covered benefits and limitations, and plan-related costs such as the monthly premium and copayments/coinsurance for services received. This information enables an informed comparison of plans and helps the consumer choose a option that fits their doctors, medications, and budget. Personal health history isn’t required for reviewing enrollment options, and current market trends in overall healthcare costs don’t determine a particular plan’s coverage or price.