Cost Sharing Rules for Members

70.3.4 - Cost Sharing Rules for Members (Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11) • The plan cannot vary a member’s actual out-of-pocket costs (regardless of whether copayment or coinsurance applies) with respect to a particular category of Part A or Part B service for direct-contracting providers. • The plan cannot vary a member’s actual out-of-pocket costs (regardless of whether copayment or coinsurance applies) with respect to a particular category of Part A or Part B service for deemed providers. • The member’s actual out-of-pocket costs (regardless of whether copayment or coinsurance applies) with respect to a particular category of Part A or Part B service may be higher when the member receives out-of-network services from a deemed provider instead of in-network services from a direct-contracting provider.