Common use of Choosing a Premier Provider Clause in Contracts

Choosing a Premier Provider. i. A Premier Provider is a participating provider under this dental plan; however, the Premier Provider has not agreed to the features of the PPO plan. The amount charged may be above that accepted by PPO Providers, and Enrollees will be responsible for balance billed amounts. Payment for covered services performed by a Premier Provider is based on the Maximum Contract Allowance, and the Enrollee may be balance billed up to the Premier Provider’s Contracted Fee. ii. Costs incurred by the Pediatric Enrollee with a Premier Provider do not count towards the Out-of-Pocket Maximum for Pediatric Benefits. Enrollee Coinsurance and other cost- sharing, including balance billed amounts, continue to apply when a Premier Provider is used even if the Out-of-Pocket Maximum for Pediatric Enrollees has been met.

Choosing a Premier Provider. i. A Premier Provider is a participating provider under this dental plan; however, the Premier Provider has not agreed to the features of the PPO plan. The amount charged may be above that accepted by PPO Providers, and Enrollees will be responsible for balance billed amounts. Payment for covered services performed by a Premier Provider is based on the Maximum Contract Allowance, and the Enrollee may be balance billed up to the Premier Provider’s Contracted Fee. ii. Costs incurred by the Pediatric Enrollee with a Premier Provider do not count towards the Out-of-of- Pocket Maximum for Pediatric Benefits. Enrollee Coinsurance and other cost- cost-sharing, including balance billed amounts, continue to apply when a Premier Provider is used even if the Out-of-of- Pocket Maximum for Pediatric Enrollees has been met.