* For more information about limitations and exceptions, see plan or policy document at https://eoc.anthem.com/eocdps/aso. 5 of " Does this plan provide Minimum Essential Coverage? Yes If you don’t have Minimum Essential Coverage for a month, you’ll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month. 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.––––––––––––––––––––––
Summary of Benefits and Coverage: Retiree Over Age 65/Medicare Disabled EGWP Health Plan CMM Page 4 Page 6