Network Providers vs. Non‐Network Providers Sample Clauses

Network Providers vs. Non‐Network Providers. Please note that your Out‐of‐Pocket Costs for Covered Services may be higher when Covered Services are provided by a Non‐ Network Provider, or “out‐of‐network”. This difference is described in more detail in your Schedule of Benefits. Under Maine law, the benefit level differential for Covered Services provided by a Network Provider and a Non‐Network Provider cannot be more than 20%. When you receive services for a Medical Emergency, your Out‐of‐Pocket Costs (up to the Maximum Allowable Amount determined by Community Health Options) will be at the Network Provider level whether you see a Network Provider or a Non‐Network Provider. Non‐emergent charges from Non‐Network Providers above the Maximum Allowable Amount will not apply to your cost‐sharing and will be your responsibility, if the Non‐Network Provider chooses to bill you (known as balance billing). This means you may have financial responsibility greater than the cost‐sharing described on your Schedule of Benefits. When there is an inadequate network, balance billing does not apply. Covered Services applied to the Non‐Network Deductible and/or Out‐of‐Pocket Maximum will not apply to the Network Deductible and/or Out‐of‐Pocket Maximum. Covered Services applied to the Network Deductible and/or Out‐of‐Pocket Maximum will not apply to the Non‐Network Deductible and/or Out‐of‐Pocket Maximum.