Covered California Certified Enroller Practice Exam

What is the responsibility of a member under the Catastrophic plan for the first three non-preventive visits?

1. Pay a copayment

2. Pay nothing

3. Pay the full cost

4. Submit a reimbursement claim

The correct answer is: Pay nothing

Under the Catastrophic plan, which is designed to provide coverage primarily for worst-case scenarios, the member has specific cost-sharing responsibilities. For the first three non-preventive visits, members are not required to pay anything. This design aims to improve access to necessary healthcare services while encouraging members to seek care without the barrier of immediate costs. This structure supports the purpose of the plan, allowing members to have a safety net for urgent or unexpected healthcare needs without incurring significant out-of-pocket expenses for these initial visits. This encourages individuals to utilize healthcare services as needed while still maintaining financial protection against higher medical costs in the event of a serious health issue. In contrast, options suggesting a copayment, full costs, or reimbursement claims do not accurately represent the intended structure and benefits of a Catastrophic plan, which is focused more on eliminating barriers for initial access to care.