Page 6 of 7 QP250022_L * For more information about limitations and exceptions, see the plan or policy document at www.phpni.com. Does this plan meet the Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace. To see examples of how this plan might cover costs for a sample medical situation, see the next section.
Plan 3 SBC Page 5 Page 7