First, direct Ella to the Important Questions chart of the SBC. Explain that Ella must meet the deductible amount in the first row before the insurance company would begin to pay for covered services. In this example, the plan has a $500 per person overall deductible and a $300 specific deductible for prescription drug coverage. Next, direct Ella to the Common Medical Events chart shown in Exhibit 3 below. This chart starts on the next page of the SBC and shows the potential cost-sharing amounts Ella might be responsible for if she received various health care services after meeting the plan’s deductible(s). For example, an office visit with a specialist in the plan’s network has a $50 copayment per visit for a participating provider, which means Ella would need to pay $50 each time she visits an in-network (participating) specialist. If Ella went to a nonparticipating provider outside this plan’s network, she would have to pay 40 percent coinsurance, or 40 percent of the allowed amount for the visit. For example, if the plan’s allowed amount for an out-of-network (nonparticipating) specialist visit is $200, her coinsurance payment of 40 percent would be $80. This amount assumes that she has met her deductible. Also, if the out-of-network specialist’s charge is more than the plan’s allowed amount, the provider may charge her for the difference between the provider’s charge and the plan’s allowed amount (sometimes called “balance billing”). For example, if the specialist’s charge was $250 in the example above, Ella could have to pay $50 ($250 specialist charge minus $200 plan allowed amount), plus the $80 coinsurance, for a total cost of $130. This is why is it often beneficial for enrollees to look for in-network providers, where out-of-pocket costs are typically lower. Ella should also pay attention to the “If you have a test” row of the Common Medical Event chart to determine the potential cost sharing for having an imaging test performed, like an MRI or CT/PET scan. Ella can find other services she may need, in the Common Medical Event chart as well, including “If you have outpatient surgery” and “If you have a hospital stay.” Either of these rows may apply, depending on whether her surgery would be performed in an outpatient or inpatient setting.