What happens when a member meets the MOOP during a policy year?

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Multiple Choice

What happens when a member meets the MOOP during a policy year?

Explanation:
MOOP, or maximum out-of-pocket, is the cap on what you have to pay for covered services in a policy year. When you reach that cap, the plan pays 100% of allowed benefits for the remainder of the year. That means you no longer owe deductible, coinsurance, or copays for covered services for the rest of the year. Premiums still apply, and charges for non-covered or out-of-network services may still be your responsibility. This is why meeting MOOP ends further cost-sharing for covered care for the rest of the policy year.

MOOP, or maximum out-of-pocket, is the cap on what you have to pay for covered services in a policy year. When you reach that cap, the plan pays 100% of allowed benefits for the remainder of the year. That means you no longer owe deductible, coinsurance, or copays for covered services for the rest of the year. Premiums still apply, and charges for non-covered or out-of-network services may still be your responsibility. This is why meeting MOOP ends further cost-sharing for covered care for the rest of the policy year.

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