The Outline of Coverage (OOC) is a brief description of the important features of your policy. This is not the insurance contract and only the actual policy document will provide complete details.

Key Details:

• Outline focuses mostly on in-network and out-of-network costs
• No examples or explanations of services

The Summary of Benefits and Coverage (SBC), for most people, will probably be the most important document to examine when comparing plans and understanding coverage options.

The SBC summarizes how your plan shares the costs for covered health care services. This is a summary of the legal requirements found in the Policy.

Key Details:

• Brief descriptions of limitations, exceptions, and other important details
• Deductibles
• Copays
• Coinsurance
• More in depth than the OOC

This is a legally binding contract between us, the insurance company, and you, the policy holder.

It details the rights and obligations, of both you and those of Mountain Health Co-Op.

Key Details:

• Highly detailed explanations of all coverage and benefits
• Explains prior authorization requirements
• Lists all excluded benefits
• out-of-network options