Common use of How Network Providers Are Clause in Contracts

How Network Providers Are. Paid This agreement pays network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- sharing, care coordination, value-based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: • during an inpatient admissions at a network facility under the supervision of a network physician; • while receiving outpatient services performed at a network facility under the supervision of a network physician; and • while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement plan pays network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- risk-sharing, care coordination, value-value- based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: • during an inpatient admissions at a network facility under the supervision of a network physician; • while receiving outpatient services performed at a network facility under the supervision of a network physician; and • while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- non-network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement pays We pay network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- risk-sharing, care coordination, value-based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: • during an inpatient admissions at a network facility under the supervision of a network physician; • while receiving outpatient services performed at a network facility under the supervision of a network physician; and • while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement pays network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- sharing, care coordination, value-based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: •  during an inpatient admissions admission at a network facility under the supervision of a network physician; •  while receiving outpatient services performed at a network facility under the supervision of a network physician; and •  while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement pays We pay network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- risk-sharing, care coordination, value-based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: •  during an inpatient admissions at a network facility under the supervision of a network physician; •  while receiving outpatient services performed at a network facility under the supervision of a network physician; and •  while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement plan pays network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- risk-sharing, care coordination, value-value- based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: •  during an inpatient admissions at a network facility under the supervision of a network physician; •  while receiving outpatient services performed at a network facility under the supervision of a network physician; and •  while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- non-network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement pays We pay network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- risk-sharing, care coordination, value-based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: •  during an inpatient admissions admission at a network facility under the supervision of a network physician; •  while receiving outpatient services performed at a network facility under the supervision of a network physician; and •  while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement pays We pay network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- risk-sharing, care coordination, value-based or similar programs. Network providers agree not to xxxxbill, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: • during an inpatient admissions admission at a network facility under the supervision of a network physician; • while receiving outpatient services performed at a network facility under the supervision of a network physician; and • while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.

How Network Providers Are. Paid This agreement pays network providers directly for covered health care services. You are responsible for copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. The copayments and deductibles you are responsible for are determined at the date of service and will not be retroactively adjusted for payments we make to providers under provider incentive, risk- sharing, care coordination, value-based or similar programs. Network providers agree not to xxxx, charge, collect a deposit from, or in any way seek reimbursement from you for a covered health care service, except for the copayments, deductibles, and the difference between the maximum benefit and our allowance, if any, which may apply to a covered health care service. It is your obligation to pay a network provider your copayment, deductible, and the difference between the maximum benefit and our allowance. If you do not pay the network provider, the provider may decline to provide current or future services to you. The provider may pursue payment from you. See Section 1.13 - Your Responsibility to Pay Your Providers for more information. Not all of the individual providers at a network facility will be network providers. It is your responsibility to make sure that each provider from whom you receive care is in the network. However, if you receive certain types of services at a network facility, and there are covered health care services provided with those services by a non-network provider outside of your control, we will reimburse you for those covered health care services based upon our allowance at the network level of benefits when the services have been rendered: •  during an inpatient admissions at a network facility under the supervision of a network physician; •  while receiving outpatient services performed at a network facility under the supervision of a network physician; and •  while receiving emergency room services at a network facility. Out-of-Network authorization requests to seek covered health care services from a non- network provider are only approved when a covered health care service cannot be provided by a network provider. When this happens, please call our Customer Service Department to discuss the options and they will assist you with the process of obtaining a network authorization. Services rendered with an approved network authorization will be paid based on network provider benefit level, as shown in the Summary of Benefits table. You will be responsible to pay the difference between the maximum benefit and our allowance, and any applicable copayments and deductibles (if any). If we approve a network authorization for you to receive services from a non-network provider, we reimburse you or the non-network provider up to the maximum benefit or our allowance, less any copayments and deductibles (if any), which may apply to a covered health care service.