Common use of How to Use This Health Plan Clause in Contracts

How to Use This Health Plan. PLEASE READ THE FOLLOWING INFORMA- TION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Choice of Providers This Blue Shield Health Plan is designed for Mem- bers to obtain services from Blue Shield Participat- ing Providers and MHSA Participating Providers. However, Members may choose to seek services from Non-Participating Providers for most ser- vices. Covered Services obtained from Non-Par- ticipating Providers will usually result in a higher share of cost for the Member. Some services are not covered unless rendered by a Participating Provider or MHSA Participating Provider. Please be aware that a provider’s status as a Partic- ipating Provider or an MHSA Participating Provider may change. It is the Member’s obliga- tion to verify whether the provider chosen is a Par- ticipating Provider or an MHSA Participating Provider prior to obtaining coverage. Call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. Call the MHSA to determine if a provider is an MHSA Par- ticipating Provider. See the sections below and the Summary of Benefits for more details. See the Out-of-Area Services section for services outside of California. Blue Shield Participating Providers Blue Shield Participating Providers include pri- xxxx care Physicians, specialists, Hospitals, and Alternate Care Services Providers that have a con- tractual relationship with Blue Shield. Participat- ing Providers are listed in the Participating Provider directory. Participating Providers agree to accept Blue Shield’s payment, plus the Member’s payment of any applicable Deductibles, Copayments, Coinsur- ance or amounts in excess of specified Benefit maximums as payment-in-full for Covered Ser- vices, except as provided under the Exception for Other Coverage and the Reductions – Third Party Liability sections. This is not true of Non-Partici- pating Providers. If a Member receives services from a Non-Partici- pating Provider, Blue Shield’s payment for that service may be substantially less than the amount billed. The Subscriber is responsible for the differ- ence between the amount Blue Shield pays and the amount billed by the Non-Participating Provider. If a Member receives services at a facility that is a Participating Provider, Blue Shield’s payment for Covered Services provided by a health profes- sional at the Participating Provider facility will be paid at the Participating Provider level of Benefits, whether the health professional is a Participating Provider or Non-Participating Provider. The Mem- ber’s share of cost will not exceed the Copayment or Coinsurance due to a participating Provider un- der similar circumstances. Some services are covered only if rendered by a Participating Provider. In these instances, using a Non-Participating Provider could result in a higher share of cost to the Member or no payment by Blue Shield for the services received. Payment for Emergency Services rendered by a Physician or Hospital that is not a Participating Provider will be based on Blue Shield’s Allowable Amount and will be paid at the Participating level of Benefits. The Member is responsible for notify- ing Blue Shield within 24 hours, or as soon as rea- sonably possible following medical stabilization of the emergency condition. Please call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. MHSA Participating Providers For Mental Health Services and Substance Use Disorder Services, Blue Shield has contracted with a Mental Health Service Administrator (MHSA). The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care, and will underwrite and de- liver Blue Shield’s Mental Health Services and Substance Use Disorder Services through a sepa- rate network of MHSA Participating Providers. MHSA Participating Providers are those providers who participate in the MHSA network and have contracted with the MHSA to provide Mental Health and Substance Use Disorder Services to Blue Shield Members. A Blue Shield Participating Provider may not be an MHSA Participating will not exceed the Copayment or Coinsurance due to an MHSA Participating Provider under similar circumstances. Continuity of Care Continuity of care with a Non-Participating Provider is available for the following Members: for Members who are currently seeing a provider who is no longer in the Blue Shield; or for newly- covered Members whose previous health plan was withdrawn from the market. Members who meet the eligibility requirements listed above may request continuity of care if they are being treated for acute conditions, serious chronic conditions, pregnancies (including imme- diate postpartum care), or terminal illness. Xxxxx- nuity of care may also be requested for children who are up to 36 months old, or for Members who have received authorization from a now-termi- nated provider for surgery or another procedure as part of a documented course of treatment. To request continuity of care, visit xxx.xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will review the request. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount as payment in full for ongoing care. When autho- rized, the Member may continue to see the Non- Participating Provider for up to 12 months at the Participating Provider rate. Provider. It is the Member’s responsibility to en- sure that the provider selected for Mental Health and Substance Use Disorder Services is an MHSA Participating Provider. MHSA Participating Providers are identified in the Blue Shield Behav- ioral Health Provider Directory. Additionally, Members may contact the MHSA directly by call- ing 0-000-000-0000. If a Member receives services at a facility that is an MHSA Participating Provider, MHSA’s pay- ment for Mental Health and Substance Use Disor- der Services provided by a health professional at the MHSA Participating Provider facility will be paid at the MHSA Participating Provider level of Benefits, whether the health professional is an MHSA Participating Provider or MHSA Non-Par- ticipating Provider. The Member’s share of cost Second Medical Opinion Policy Members who have questions about their diag- noses, or believe that additional information con- cerning their condition would be helpful in deter- mining the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s at- tending Physician may also offer a referral to an- other Physician for a second opinion. The second opinion visit is subject to the applica- ble Copayment, Coinsurance, Calendar Year De- ductible and all Plan Contract Benefit limitations and exclusions. State law requires that health plans disclose to Members, upon request, the timelines for respond- ing to a request for a second medical opinion. To request a copy of these timelines, you may call the Customer Service Department at the number pro- vided on the back page of this EOC.

How to Use This Health Plan. PLEASE READ THE FOLLOWING INFORMA- TION INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Choice of Providers This Exclusive Provider Organization (EPO) benefit plan utilizes a network of Participating Providers. Except for Emergency Services or Urgent Services, or when authorized by Blue Shield Shield, Members must obtain care from a Participating Provider. Mental Health Plan is designed for Mem- bers to obtain services and Substance Abuse Services must be obtained from Blue Shield Participat- ing Providers and MHSA Participating Providers. However, Members may choose to seek services The EPO benefit plan does not provide benefits for non- Emergency or non-Urgent Services from Non-Participating Providers for most ser- vices. Covered Services obtained from or Non-Par- ticipating Providers will usually result in a higher share of cost Preferred Providers. Also, the Plan provides no benefits for the Member. Some services are not covered unless non-Emergency or non-Urgent Mental Health and Substance Abuse Services when rendered by a MHSA Non-Participating Provider or MHSA Participating ProviderProviders. Please be aware that a provider’s status as a Partic- ipating Participating Provider or an MHSA Participating Provider may change. It is the Member’s obliga- tion obligation to verify whether the provider chosen is a Par- ticipating Participating Provider or an MHSA Participating Provider prior to obtaining coverage. Call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. Call the MHSA to determine if a provider is an MHSA Par- ticipating Participating Provider. See the sections below and the Summary of Benefits for more details. See the Out-of-Area Services Programs section for services outside of California. Blue Shield Participating Providers Blue Shield Participating Providers include pri- xxxx primary care Physicians, specialists, Hospitals, and Alternate Care Services Providers, and Other Providers that have a con- tractual contractual relationship with Blue Shield. Participat- ing Participating Providers are listed in the Participating Provider directory. Except for Emergency Services or urgent services or when authorized by Blue Shield, all Covered Services must be provided by a Participating Provider (or an MHSA Participating Provider for Mental Health Services or Substance Abuse Services). Participating Providers agree to accept Blue Shield’s payment, plus the Member’s payment of any applicable Deductibles, Copayments, Coinsur- ance and Coinsurance or amounts in excess of specified Benefit maximums as payment-in-full for Covered Ser- vicesServices, except as provided under the Exception for Other Coverage and the Reductions – Reductions-Third Party Liability sections. This is not true of Non-Partici- pating Providers. If a Member receives services from a Non-Partici- pating Provider, Blue Shield’s payment for that service may be substantially less than the amount billed. The Subscriber is responsible for the differ- ence between the amount Blue Shield pays and the amount billed by the Non-Participating Provider. If a Member receives services at a facility that is a Participating Provider, Blue Shield’s payment for Covered Services provided by a health profes- sional at the Participating Provider facility will be paid at the Participating Provider level of Benefits, whether the health professional is a Participating Provider or Non-Participating Provider. The Mem- ber’s share of cost will not exceed the Copayment or Coinsurance due to a participating Provider un- der similar circumstances. Some services are covered only if rendered by a Participating Provider. In these instances, using a Non-Participating Provider could result in a higher share of cost to the Member or no payment by Blue Shield for the services received. Payment for Emergency Services rendered by a Physician or Hospital that is not a Participating Provider will be based on Blue Shield’s Allowable Amount and will be paid at the Participating level of Benefits. The Member is responsible for notify- ing notifying Blue Shield within 24 hours, or as soon as rea- sonably reasonably possible following medical stabilization of the emergency condition. The Member should contact Member Services if the Member needs assistance locating a provider in the Member’s Service Area. The Plan will review and consider a Member’s request for services that cannot be reasonably obtained in network. If a Member’s request for services from a Non-Participating Provider is approved at an in- network benefit level, the Plan will pay for Covered Services at a Participating Provider level. Please call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. MHSA Participating Providers For Mental Health Services and Substance Use Disorder Abuse Services, Blue Shield has contracted with a Mental Health Service Administrator (MHSA). The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care, and will underwrite and de- liver deliver Blue Shield’s Mental Health Services and Substance Use Disorder Abuse Services through a sepa- rate separate network of MHSA Participating Providers. Except for Emergency Services or urgent services or when authorized by the MHSA, all covered Mental Health and Substance Abuse Services must be provided by an MHSA Participating Provider. MHSA Participating Providers are those providers who participate in the MHSA network and have contracted with the MHSA to provide Mental Health Services and Substance Use Disorder Abuse Services to Blue Shield Members. A Blue Shield Participating Provider may not be an MHSA Participating will not exceed the Copayment or Coinsurance due to an MHSA Participating Provider under similar circumstances. Continuity of Care Continuity of care with a Non-Participating Provider is available for the following Members: for Members who are currently seeing a provider who is no longer in the Blue Shield; or for newly- covered Members whose previous health plan was withdrawn from the market. Members who meet the eligibility requirements listed above may request continuity of care if they are being treated for acute conditions, serious chronic conditions, pregnancies (including imme- diate postpartum care), or terminal illness. Xxxxx- nuity of care may also be requested for children who are up to 36 months old, or for Members who have received authorization from a now-termi- nated provider for surgery or another procedure as part of a documented course of treatment. To request continuity of care, visit xxx.xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will review the request. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount as payment in full for ongoing care. When autho- rized, the Member may continue to see the Non- Participating Provider for up to 12 months at the Participating Provider rate. Provider. It is the Member’s responsibility to en- sure ensure that the provider selected for Mental Health and Substance Use Disorder Abuse Services is an MHSA Participating Provider. MHSA Participating Providers are identified in the Blue Shield Behav- ioral Behavioral Health Provider Directory. Additionally, Members may contact the MHSA directly by call- ing calling 0-000-000-0000. If a Member receives services at a facility that is an MHSA Participating Provider, MHSA’s pay- ment for Mental Health and Substance Use Disor- der Services provided by a health professional at the MHSA Participating Provider facility will be paid at the MHSA Participating Provider level of Benefits, whether the health professional is an MHSA Participating Provider or MHSA Non-Par- ticipating Provider. The Member’s share of cost Second Medical Opinion Policy Members who have questions about their diag- noses, or believe that additional information con- cerning their condition would be helpful in deter- mining the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s at- tending Physician may also offer a referral to an- other Physician for a second opinion. The second opinion visit is subject to the applica- ble Copayment, Coinsurance, Calendar Year De- ductible and all Plan Contract Benefit limitations and exclusions. State law requires that health plans disclose to Members, upon request, the timelines for respond- ing to a request for a second medical opinion. To request a copy of these timelines, you may call the Customer Service Department at the number pro- vided on the back page of this EOC.

How to Use This Health Plan. PLEASE READ THE FOLLOWING INFORMA- TION INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Choice of Providers This Exclusive Provider Organization (EPO) benefit plan utilizes a network of Participating Providers. Except for Emergency Services or Urgent Services, or when authorized by Blue Shield Shield, Members must obtain care from a Participating Provider. Mental Health Plan is designed for Mem- bers to obtain services and Substance Abuse Services must be obtained from Blue Shield Participat- ing Providers and MHSA Participating Providers. However, Members may choose to seek services The EPO benefit plan does not provide benefits for non- Emergency or non-Urgent Services from Non-Participating Providers for most ser- vices. Covered Services obtained from or Non-Par- ticipating Providers will usually result in a higher share of cost Preferred Providers. Also, the Plan provides no benefits for the Member. Some services are not covered unless non-Emergency or non-Urgent Mental Health and Substance Abuse Services when rendered by a MHSA Non-Participating Provider or MHSA Participating ProviderProviders. Please be aware that a provider’s status as a Partic- ipating Participating Provider or an MHSA Participating Provider may change. It is the Member’s obliga- tion obligation to verify whether the provider chosen is a Par- ticipating Participating Provider or an MHSA Participating Provider prior to obtaining coverage. Call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. Call the MHSA to determine if a provider is an MHSA Par- ticipating Participating Provider. See the sections below and the Summary of Benefits for more details. See the Out-of-Area Services Programs section for services outside of California. Blue Shield Participating Providers Blue Shield Participating Providers include pri- xxxx primary care Physicians, specialists, Hospitals, and Alternate Care Services Providers, and Other Providers that have a con- tractual contractual relationship with Blue Shield. Participat- ing Participating Providers are listed in the Participating Provider directory. Except for Emergency Services or Urgent Services or when authorized by Blue Shield, all Covered Services must be provided by a Participating Provider (or an MHSA Participating Provider for Mental Health Services or Substance Abuse Services). Participating Providers agree to accept Blue Shield’s payment, plus the Member’s payment of any applicable Deductibles, Copayments, Coinsur- ance and Coinsurance or amounts in excess of specified Benefit maximums as payment-in-full for Covered Ser- vicesServices, except as provided under the Exception for Other Coverage and the Reductions – Reductions-Third Party Liability sections. This is not true of Non-Partici- pating Providers. If a Member receives services from a Non-Partici- pating Provider, Blue Shield’s payment for that service may be substantially less than the amount billed. The Subscriber is responsible for the differ- ence between the amount Blue Shield pays and the amount billed by the Non-Participating Provider. If a Member receives services at a facility that is a Participating Provider, Blue Shield’s payment for Covered Services provided by a health profes- sional at the Participating Provider facility will be paid at the Participating Provider level of Benefits, whether the health professional is a Participating Provider or Non-Participating Provider. The Mem- ber’s share of cost will not exceed the Copayment or Coinsurance due to a participating Provider un- der similar circumstances. Some services are covered only if rendered by a Participating Provider. In these instances, using a Non-Participating Provider could result in a higher share of cost to the Member or no payment by Blue Shield for the services received. Payment for Emergency Services rendered by a Physician or Hospital that is not a Participating Provider will be based on Blue Shield’s Allowable Amount and will be paid at the Participating level of Benefits. The Member is responsible for notify- ing notifying Blue Shield within 24 hours, or as soon as rea- sonably reasonably possible following medical stabilization of the emergency condition. The Member should contact Member Services if the Member needs assistance locating a provider in the Member’s Service Area. The Plan will review and consider a Member’s request for services that cannot be reasonably obtained in network. If a Member’s request for services from a Non-Participating Provider is approved at an in- network benefit level, the Plan will pay for Covered Services at a Participating Provider level. Please call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. MHSA Participating Providers For Mental Health Services and Substance Use Disorder Abuse Services, Blue Shield has contracted with a Mental Health Service Administrator (MHSA). The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care, and will underwrite and de- liver deliver Blue Shield’s Mental Health Services and Substance Use Disorder Abuse Services through a sepa- rate separate network of MHSA Participating Providers. Except for Emergency Services or Urgent Services or when authorized by the MHSA, all covered Mental Health and Substance Abuse Services must be provided by an MHSA Participating Provider. MHSA Participating Providers are those providers who participate in the MHSA network and have contracted with the MHSA to provide Mental Health Services and Substance Use Disorder Abuse Services to Blue Shield Members. A Blue Shield Participating Provider may not be an MHSA Participating will not exceed the Copayment or Coinsurance due to an MHSA Participating Provider under similar circumstances. Continuity of Care Continuity of care with a Non-Participating Provider is available for the following Members: for Members who are currently seeing a provider who is no longer in the Blue Shield; or for newly- covered Members whose previous health plan was withdrawn from the market. Members who meet the eligibility requirements listed above may request continuity of care if they are being treated for acute conditions, serious chronic conditions, pregnancies (including imme- diate postpartum care), or terminal illness. Xxxxx- nuity of care may also be requested for children who are up to 36 months old, or for Members who have received authorization from a now-termi- nated provider for surgery or another procedure as part of a documented course of treatment. To request continuity of care, visit xxx.xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will review the request. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount as payment in full for ongoing care. When autho- rized, the Member may continue to see the Non- Participating Provider for up to 12 months at the Participating Provider rate. Provider. It is the Member’s responsibility to en- sure ensure that the provider selected for Mental Health and Substance Use Disorder Abuse Services is an MHSA Participating Provider. MHSA Participating Providers are identified in the Blue Shield Behav- ioral Behavioral Health Provider Directory. Additionally, Members may contact the MHSA directly by call- ing 0calling 1-000-877- 000-0000. If a Member receives services at a facility that is an MHSA Participating Provider, MHSA’s pay- ment for Mental Health and Substance Use Disor- der Services provided by a health professional at the MHSA Participating Provider facility will be paid at the MHSA Participating Provider level of Benefits, whether the health professional is an MHSA Participating Provider or MHSA Non-Par- ticipating Provider. The Member’s share of cost Second Medical Opinion Policy Members who have questions about their diag- noses, or believe that additional information con- cerning their condition would be helpful in deter- mining the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s at- tending Physician may also offer a referral to an- other Physician for a second opinion. The second opinion visit is subject to the applica- ble Copayment, Coinsurance, Calendar Year De- ductible and all Plan Contract Benefit limitations and exclusions. State law requires that health plans disclose to Members, upon request, the timelines for respond- ing to a request for a second medical opinion. To request a copy of these timelines, you may call the Customer Service Department at the number pro- vided on the back page of this EOC.

How to Use This Health Plan. PLEASE READ THE FOLLOWING INFORMA- TION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Choice of Providers This Blue Shield Health Plan is designed for Mem- bers to obtain services from Blue Shield Participat- ing Providers and MHSA Participating Providers. However, Members may choose to seek services from Non-Participating Providers for most ser- vices. Covered Services obtained from Non-Par- ticipating Providers will usually result in a higher share of cost for the Member. Some services are not covered unless rendered by a Participating Provider or MHSA Participating Provider. Please be aware that a provider’s status as a Partic- ipating Provider or an MHSA Participating Provider may change. It is the Member’s obliga- tion to verify whether the provider chosen is a Par- ticipating Provider or an MHSA Participating Provider prior to obtaining coverage. Call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. Call the MHSA to determine if a provider is an MHSA Par- ticipating Provider. See the sections below and the Summary of Benefits for more details. See the Out-of-Area Services section for services outside of California. Blue Shield Participating Providers Blue Shield Participating Providers include pri- xxxx care Physicians, specialists, Hospitals, and Alternate Care Services Providers that have a con- tractual relationship with Blue Shield. Participat- ing Providers are listed in the Participating Provider directory. Participating Providers agree to accept Blue Shield’s payment, plus the Member’s payment of any applicable Deductibles, Copayments, Coinsur- ance or amounts in excess of specified Benefit maximums as payment-in-full for Covered Ser- vices, except as provided under the Exception for Other Coverage and the Reductions – Third Party Liability sections. This is not true of Non-Partici- pating Providers. If a Member receives services from a Non-Partici- pating Provider, Blue Shield’s payment for that service may be substantially less than the amount billed. The Subscriber is responsible for the differ- ence between the amount Blue Shield pays and the amount billed by the Non-Participating Provider. If a Member receives services at a facility that is a Participating Provider, Blue Shield’s payment for Covered Services provided by a health profes- sional at the Participating Provider facility will be paid at the Participating Provider level of Benefits, whether the health professional is a Participating Provider or Non-Participating Provider. The Mem- ber’s share of cost will not exceed the Copayment or Coinsurance due to a participating Provider un- der similar circumstances. Some services are covered only if rendered by a Participating Provider. In these instances, using a Non-Participating Provider could result in a higher share of cost to the Member or no payment by Blue Shield for the services received. Payment for Emergency Services rendered by a Physician or Hospital that is not a Participating Provider will be based on Blue Shield’s Allowable Amount and will be paid at the Participating level of Benefits. The Member is responsible for notify- ing Blue Shield within 24 hours, or as soon as rea- sonably possible following medical stabilization of the emergency condition. x Please call Customer Service or visit xxx.xxxxxxxxxxxx.xxx to determine whether a provider is a Participating Provider. MHSA Participating Providers For Mental Health Services and Substance Use Disorder Services, Blue Shield has contracted with a Mental Health Service Administrator (MHSA). The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care, and will underwrite and de- liver Blue Shield’s Mental Health Services and Substance Use Disorder Services through a sepa- rate network of MHSA Participating Providers. MHSA Participating Providers are those providers who participate in the MHSA network and have contracted with the MHSA to provide Mental Health and Substance Use Disorder Services to Blue Shield Members. A Blue Shield Participating Provider may not be an MHSA Participating will not exceed the Copayment or Coinsurance due to an MHSA Participating Provider under similar circumstances. Continuity of Care Continuity of care with a Non-Participating Provider is available for the following Members: for Members who are currently seeing a provider who is no longer in the Blue Shield; or for newly- covered Members whose previous health plan was withdrawn from the market. Members who meet the eligibility requirements listed above may request continuity of care if they are being treated for acute conditions, serious chronic conditions, pregnancies (including imme- diate postpartum care), or terminal illness. Xxxxx- nuity of care may also be requested for children who are up to 36 months old, or for Members who have received authorization from a now-termi- nated provider for surgery or another procedure as part of a documented course of treatment. To request continuity of care, visit xxx.xxxxxxxxxxxx.xxx and fill out the Continuity of Care Application. Blue Shield will review the request. The Non-Participating Provider must agree to accept Blue Shield’s Allowable Amount as payment in full for ongoing care. When autho- rized, the Member may continue to see the Non- Participating Provider for up to 12 months at the Participating Provider rate. Provider. It is the Member’s responsibility to en- sure that the provider selected for Mental Health and Substance Use Disorder Services is an MHSA Participating Provider. MHSA Participating Providers are identified in the Blue Shield Behav- ioral Health Provider Directory. Additionally, Members may contact the MHSA directly by call- ing 0-000-000-0000. If a Member receives services at a facility that is an MHSA Participating Provider, MHSA’s pay- ment for Mental Health and Substance Use Disor- der Services provided by a health professional at the MHSA Participating Provider facility will be paid at the MHSA Participating Provider level of Benefits, whether the health professional is an MHSA Participating Provider or MHSA Non-Par- ticipating Provider. The Member’s share of cost Second Medical Opinion Policy Members who have questions about their diag- noseswill not exceed the Copayment or Coinsurance due to an MHSA Participating Provider under similar circumstances. Physician or Hospital that is not a Participating Provider will be based on Blue Shield’s Allowable Amount and will be paid at the Participating level of Benefits. The Member is responsible for notify- ing Blue Shield within 24 hours, or believe that additional information con- cerning their condition would be helpful in deter- mining as soon as rea- sonably possible following medical stabilization of the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s at- tending Physician may also offer a referral to an- other Physician for a second opinion. The second opinion visit is subject to the applica- ble Copayment, Coinsurance, Calendar Year De- ductible and all Plan Contract Benefit limitations and exclusions. State law requires that health plans disclose to Members, upon request, the timelines for respond- ing to a request for a second medical opinion. To request a copy of these timelines, you may call the Customer Service Department at the number pro- vided on the back page of this EOCemergency condition.