Non-Network Benefits. Benefits for Covered Services received from Non-Network Providers (Providers not contracted in the Preferred Care or another Blue plan’s PPO Network). These are Non-Participating Providers.
Non-Network Benefits. See your Non-Network Benefits individual deductible under your Medical Plan Benefits Chart.
Non-Network Benefits. See your Non-Network Benefits family deductible under your Medical Plan Benefits Chart. Your Individual and Family deductible amounts may be indexed to allow for deductible amount changes under federal rules.
Non-Network Benefits. See your Non-Network Benefits family out-of- pocket limit under your Medical Plan Benefits Chart. Your Individual and Family Out-of-Pocket amounts may be indexed to allow for out-of-pocket amount changes under federal rules.
Non-Network Benefits. For all other services that meet the home health services requirements described in the SPD, there is a maximum of 60 visits per calendar year. Each visit provided under the Network Benefits and Non-Network Benefits, combined, counts toward the maximums shown above. Network Benefits 100% of the charges incurred. Deductible does not apply. Non-Network Benefits 55% of the charges incurred, after you pay the deductible. The routine postnatal well child visits do not count toward the visit limits above. • Please refer to the “SERVICES NOT COVERED” section. HOME HOSPICE SERVICES
Non-Network Benefits. Non-Network Benefits apply when a Covered Person decides to obtain Health Services from non-Network Providers. Non-Network Providers may request payment of all charges when services are rendered. A claim must be filed with The Company for reimbursement of Eligible Expenses. If a Co-payment applies to Non-Network Benefits, the amount of the Co-payment will be deducted from the amount reimbursed to the Primary Insured.
Non-Network Benefits a. Non-network benefits will be provided when:
1. covered individuals do not use their designated gatekeeper and the procedures established for use of the gatekeeper when seeking outpatient care, or
2. elect not to use a network provider, or
3. a network provider is not available to provide the service.
b. Inpatient hospital semi-private room and board, services and supplies will be reimbursed at 80% of allowable expenses after a $200 deductible per admission.
c. Fees for inpatient doctor's visits, radiologist's fees, anesthesiologists, surgeons or assistant surgeons (in a hospital where an intern resident or a house staff member is not available) during an inpatient confinement will be reimbursed at 80% of allowable expenses after the $200 deductible per admission.
d. Emergency services will be covered in full as defined in 6.2b.
e. The following outpatient services will be reimbursed at 80% of allowable expenses after a $100 per person outpatient deductible, per health insurance contract year:
1. doctor's office visits for the treatment of illness or injury, subject to a limit of 10 visits per covered individual, per health insurance contract year,
2. hospital outpatient facility charges,
3. outpatient surgeon's, anesthesiologist's and radiologist's charges, x-ray, lab and pathology services,
4. outpatient specialty care,
5. maternity care except that the 10 visit limit for doctor's office (pre and post- natal) visits will not apply,
6. annual cytology screening,
7. mammography screening subject to the guidelines for coverage as outlined in 6.2g.,
8. short term physical therapy, 9. chemotherapy, hemodialysis and radiation therapy.
f. Certain outpatient services will require pre-certification. These services include: elective outpatient services as defined by the successful vendor insurance carrier, mental health, alcohol and substance abuse services, physical therapy, hospice care, home health care and non-emergency ambulance services.
g. If a covered individual purchases prescription drugs from a non-network pharmacy, the covered individual must remit payment to the pharmacy and submit for reimbursement to the successful vendor insurance carrier. If the covered individual purchases a generic or single source brand-name drug, the Plan will reimburse the individual less a $6.00 copayment. If the covered individual purchases a brand-name when a generic equivalent is available, the Plan will reimburse the individual the cost of the generic drug less a $6.00...
Non-Network Benefits. Non-network benefits will be provided when:
1. When covered individuals do not elect to use a network provider, or
2. A network provider is not available to provide the service. Non-network Hospital Inpatient. Inpatient hospital semi-private room and board, services and supplies will be reimbursed at 80% of allowable expenses after a $200 deductible per admission. Fees for inpatient doctor's visits, radiologist's fees, anesthesiologists, surgeons or assistant surgeons (in a hospital where an intern resident or a house staff member is not available) during an inpatient confinement will be reimbursed at 80% of allowable expenses after the $200 deductible per admission. Non-network Emergency Care. Emergency services will be covered in full subject to the $15.00 copayment. Effective June 1, 2005, the copayment will be $25.00. Non-network Hospital Outpatient. The following outpatient services will be reimbursed at 80% of allowable expenses after a $100 per person outpatient deductible, per health insurance contract year:
1. Doctor’s office visits for the treatment of illness or injury,
2. Hospital outpatient facility charges,
3. Outpatient surgeon's, anesthesiologist's and radiologist's charges, x-ray, lab and pathology services,
4. Outpatient specialty care,
5. Maternity care except that the visit limit for doctor's office (pre and post-natal) visits will not apply,
6. Annual cytology screening, mammography screening subject to the guidelines for coverage as outlined in §6.2.
7. Chemotherapy, hemodialysis and radiation therapy. Non-network Outpatient Physical Therapy & Chiropractic Care. Short-term physical therapy and chiropractic treatment will be reimbursed up to 80% after a separate $100 deductible. Non-network Pre-certification For Outpatient Procedures. Certain outpatient services will require pre-certification. These services include: elective outpatient services as defined by the insurance carrier, mental health, alcohol and substance abuse services, physical therapy, hospice care, home health care and non-emergency ambulance services.
Non-Network Benefits. See your Non-Network Benefits individual deductible under your Medical Plan Benefits Chart. Family Calendar Year Deductible
Non-Network Benefits. See your Non-Network Benefits individual out-of-pocket limit under your Medical Plan Benefits Chart. Family Calendar Year Out-of-Pocket Limit
