Common use of Copayments - BlueCard Program Clause in Contracts

Copayments - BlueCard Program. Exhibit 1 attached to this Agreement describes the BlueCard Program available through the BCBSA. If the BCBSA revises the disclosure in Exhibit 1, BCN will give Group notice with a new Exhibit 1, which will automatically become part of this Agreement sixty (60) days after notice has been given. Out-of-Area Services Overview Terms and Conditions - Part A New Group Exhibit 1 BlueCard Program Group Exec Initials Federal Tax ID Number - Blue Care Network (“BCN”) has a variety of relationships with other Blue Cross and/or Blue Shield Licensees referred to generally as “Inter-Plan Arrangements.” These Inter-Plan Arrangements operate under rules and procedures issued by the Blue Cross Blue Shield Association (“Association”). Whenever you, the Member, access healthcare services outside the geographic area we serve, the claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described generally below. Typically, when accessing care outside the geographic area BCN serves, you obtain care from healthcare providers that have a contractual agreement (“participating providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from providers in the Host Blue geographic area that do not have a contractual agreement (”nonparticipating providers”) with the Host Blue. BCN remains responsible for fulfilling our contractual obligations to you. Our payment practices in both instances are described below. BCN covers only limited healthcare services received outside of our Service Area. As used in this section “Out-of-Area Covered Healthcare Services” include, emergency care, urgent care, and/or follow-up care obtained outside the geographic area we serve. Any other services will not be covered when processed through any Inter-Plan Arrangements, unless Preauthorized by your Primary Care Physician (“PCP”) or BCN. Inter-Plan Arrangements Eligibility – Claim Types All claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all Dental Care Benefits except when paid as medical claims/benefits, and those Prescription Drug Benefits or Vision Care Benefits that may be administered by a third party contracted by BCN to provide the specific service or services.

Copayments - BlueCard Program. Exhibit 1 attached to this Agreement describes the BlueCard Program available through the BCBSA. If the BCBSA revises the disclosure in Exhibit 1, BCN will give Group notice with a new Exhibit 1, which will automatically become part of this Agreement sixty (60) days after notice has been given. Out-of-Area Services Overview 3770176067 Terms and Conditions - Part A New Group Exhibit 1 BlueCard Program Group Exec Initials I. Out-of-Area Services Federal Tax ID Number - Blue Care Network (“BCN”) BCN has a variety of relationships with other Blue Cross and/or Blue Shield Licensees referred to generally as “"Inter-Plan ArrangementsPrograms.” These Inter-Plan Arrangements operate under rules and procedures issued by the Blue Cross Blue Shield Association (“Association”). " Whenever you, the Member, Members access healthcare services outside the geographic area we serveBCN serves, the claim for those services may be processed through one of these Inter-Plan ArrangementsPrograms and presented to BCN for payment in accordance with the rules of the Inter-Plan Programs policies then in effect. The Inter-Plan Arrangements Programs available to Members under this Agreement are described generally below. Typically, Members, when accessing care outside the geographic area BCN serves, you obtain care from healthcare providers that have a contractual agreement (“i.e., are "participating providers”") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“"Host Blue”"). In some instances, you Members may obtain care from providers in the Host Blue geographic area that do not have a contractual agreement (”nonparticipating non-participating healthcare providers”) with the Host Blue. BCN remains responsible for fulfilling our contractual obligations to you. Our BCN's payment practices in both instances are described below. BCN covers only limited healthcare services received outside of our Service AreaMichigan. As used in this section “Exhibit 1, "Out-of-Area Covered Healthcare Services” include, emergency care, urgent care, and/or follow-up care " include HPHUJHQF\ DQG XUJHQW VHUYLFHV obtained outside the geographic area we serveof Michigan. Any other services will not be covered when processed through any Inter-Plan Arrangements, Programs arrangements unless Preauthorized these "other services" are pre-authorized by your Primary Care Physician Member's primary care physician (“"PCP”") or BCN. Interare routine and follow-Plan Arrangements Eligibility – Claim Types All claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all Dental Care Benefits except when paid as medical claims/benefits, and those Prescription Drug Benefits or Vision Care Benefits that may be administered up care provided by a third party contracted by BCN to provide the specific service or servicesparticipating provider in another Blue Plan's network.