This Grandfathered health plan is required by the CAA to offer price comparison guidance by telephone and an internet website price comparison tool that (to the extent practicable) allows an individual participant, spouse or dependent to compare the amount of cost-sharing they would be responsible for paying under this plan for a specific item or service provided by a preferred provider to the plan.

A price comparison estimate is subject to, and does not change or supercede, any of the plan’s provisions or Rules and Regulations. Seeking a price comparison estimate is not filing a claim and does not adjust any claim. A price comparison estimate is not a pre-authorization to obtain any item or service. A price comparison estimate is not a determination of eligibility, coverage, or medical necessity. A price comparison estimate is not medical advice.

A price comparison estimate has significant limitations you should consider. A price comparison estimate is based upon CPT code(s) for specific items and services. The CPT code(s) ultimately billed by the plan’s preferred provider may be different or modified from the CPT code(s) used in the price comparison estimate. The items or services ultimately provided to you by the plan’s preferred provider may be different from the items or services for which you requested a price comparison estimate. The plan’s preferred provider may provide you items or services in addition to the items and services in the price comparison estimate. These variances can result in a higher amount of cost-sharing you will be responsible for paying. Therefore, a price comparison estimate is not a guaranty of the amount of cost-sharing you will be responsible for paying.

Please contact the plan’s customer service at 775-826-7200 with any questions.