Enrollee Costs; Disclosure. Contractor shall, and shall require Participating Providers to, comply with applicable laws, rules and regulations governing liability of Enrollees for Covered Services provided to Enrollees, including, those relating to holding an Enrollee harmless from liability in the event Contractor fails to pay an amount owed by Contractor to a Participating Provider as required by Federal and State laws, rules and regulations. To the extent that Contractor’s QHPs either (i) provide coverage for out-of-network services, or (ii) impose additional fees for such services, Contractor shall disclose to the Covered California Enrollee, at the Covered California Enrollee’s request, the amount Contractor will pay for covered proposed non-emergency out-of-network services. Contractor shall require its Participating Providers to inform every Covered California Enrollee in a manner that allows the Covered California Enrollee the opportunity to act upon a Participating Provider’s proposal or recommendation regarding (i) the use of a non-network provider or facility, or (ii) the referral of a Covered California Enrollee to a non-network provider or facility for proposed non-emergency Covered Services. Contractor shall require Participating Providers to disclose to a Covered California Enrollee considering accessing non-emergency services from a network provider if a non-network provider or facility will be used as part of the network provider’s plan of care. The Contractor’s obligation for this provision can be met through routine updates to its provider manual. Participating Providers may rely on Contractor’s provider directory in fulfilling their obligation under this provision.
Enrollee Costs; Disclosure. Contractor shall, and shall require Participating Providers to, comply with applicable laws, rules and regulations governing liability of Enrollees for Specialized Health Care Services provided to Enrollees, including those relating to holding an Enrollee harmless from liability in the event Contractor fails to pay an amount owing by Contractor to a Participating Provider as required by Federal and State laws, rules and regulations. To the extent that Contractor’s QDPs either (i) provide coverage for out-of-network services or (ii) impose additional fees for such services, Contractor shall disclose to the Enrollee, at the enrollee’s request, the amount or percentage Contractor will pay for covered proposed non-emergency out-of-network services. Contractor shall require its Participating Providers to inform every Enrollee in a manner that allows the Enrollee the opportunity to act upon a Participating Provider’s proposal or recommendation regarding (i) the use of a non-network provider or facility or (ii) the referral of an Enrollee to a non-network provider or facility for proposed non-emergency Covered Services. Contractor shall require Participating Providers to disclose to an Enrollee considering accessing non-emergency services from a network provider if a non- network provider or facility will be used as part of the network provider’s plan of care. The Contractor’s obligation for this provision can be met through routine updates to their provider manual. Participating Providers may rely on Contractor’s provider directory in fulfilling their obligation under this provision.
Enrollee Costs; Disclosure. Contractor shall, and shall require Participating Providers to, comply with applicable laws, rules and regulations governing liability of Enrollees for Covered Services provided to Enrollees, including, those relating to holding an Enrollee harmless from liability in the event Contractor fails to pay an amount owing by Contractor to a Participating Provider as required by Federal and State laws, rules and regulations. To the extent that Contractor’s QHPs either (i) provide coverage for out-of-network services, or
