Cost Sharing: Co-Insurance and Co-Payment "Not Applicable"
Question:
When coinsurance has Not Applicable, can we put $0.0 for copay_amount and NO-CHARGE for copay_opt?When co-payment has Not Applicable, can we put 0.0 for coinsurance_rate and NO-CHARGE for coinsurance_opt?
Answer:
If a benefit is not subject to coinsurance then that should be
indicated in the coinsurance fields. The copay fields are to
indicate copay subjectivity and copay amounts.
If a benefit is subject to neither coinsurance OR copay, then coinsurance and copay fields should be completed to indicate those fields are not applicable.
Please keep in mind that the directions for benefits and cost
sharing entered in the QHP templates include specific
values for display logic in order to make sure the benefits
display properly on HealthCare.gov. The machine-readable data is
not necessarily the same as the QHP templates, and should reflect
the benefits as closely as possible within the machine-readable
JSON file format. For 2016, the benefits and cost sharing entered
in the JSON files do not display on HealthCare.gov.