Common use of Reminder Clause in Contracts

Reminder. If You utilize an In-Network Provider, the Provider will send Us a claim on Your behalf. If You utilize an Out-of-Network Provider or Other Eligible Provider, the Provider may or may not file a claim on Your behalf. Member Cost Share For certain Covered Services, You may be required to pay all or a part of the Negotiated Fee Rate as Your Cost Share amount (Deductible, Copayment, and/or Coinsurance). See the SUMMARY OF BENEFITS and the section titled WHAT IS COVERED – MEDICAL for Your Cost Share responsibilities and limitations, or call Us at 1-855-Oscar-55 to learn how this Plan’s benefits or Cost Share amounts may vary by the type of Provider You use. Oscar will not provide any reimbursement for non-Covered Services. You may be responsible for the total amount billed by Your Provider for non-Covered Services, regardless of whether such services are performed by an In-Network Provider or Other Eligible Provider. Network Providers are prohibited by their contract with Us from billing or collecting from You for any services that are provided but denied because they are not Medically Necessary unless they obtain a written agreement from You wherein You agree to pay for such services. Out-of-Network Providers do not have a contract with Us and You will be responsible for the total amount billed by an Out-of-Network Provider for services that are denied because they are not Medically Necessary. Timely Access to Care We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. • Xxxxxx care appointments not requiring authorization may be obtained within forty-eight (48) hours of the request for an appointment • Xxxxxx care appointments requiring authorization may be obtained within ninety-six (96) hours of the request for an appointment • Non-urgent appointments for primary care may be obtained withinten (10) business days of the request for an appointment • Non-urgent appointments with specialist physicians may be obtained within fifteen

Reminder. If You utilize an In-Network Provider, the Provider will send Us a claim on Your behalf. If You utilize an Out-of-Network Provider or Other Eligible ProviderProviders, the Provider may or may not file a claim on Your behalf. Member Cost Share For certain Covered Services, You may be required to pay all or a part of the Negotiated Fee Rate as Your Cost Share amount (Deductible, Copayment, and/or Coinsurance). See the SUMMARY OF BENEFITS and the section titled WHAT IS COVERED – MEDICAL for Your Cost Share responsibilities and limitations, or call Us at 1-855-Oscar-55 to learn how this Plan’s benefits or Cost Share amounts may vary by the type of Provider You use. Oscar will not provide any reimbursement for non-Covered Services. You may be responsible for the total amount billed by Your Provider for non-Covered Services, regardless of whether such services are performed by an In-Network Provider or Other Eligible Provider. Network Providers are prohibited by their contract with Us from billing or collecting from You for any services that are provided but denied because they are not Medically Necessary unless they obtain a written agreement from You wherein You agree to pay for such services. Out-of-Network Providers do not have a contract with Us and You will be responsible for the total amount billed by an Out-of-Network Provider for services that are denied because they are not Medically Necessary. Timely Access to Care We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. • Xxxxxx care appointments not requiring authorization may be obtained within forty-forty- eight (48) hours of the request for an appointment appointment. • Xxxxxx care appointments requiring authorization may be obtained within ninety-ninety- six (96) hours of the request for an appointment appointment. • Non-urgent appointments for primary care may be obtained withinten within ten (10) business days of the request for an appointment appointment. • Non-urgent appointments with specialist physicians may be obtained within fifteenfifteen (15) business days of the request for appointment. • Non-urgent appointments with a non-physician mental health care provider may be obtained within ten (10) business days of the request for an appointment. • Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness or other health conditions may be obtained within fifteen (15) business days of the request for an appointment. • Telephone triage or screening service wait time shall not exceed thirty (30) minutes. The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with the professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the Members. Preventive care services, and periodic follow up care, including but not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. Xxxxx provides interpretation services, as described in the “Introduction” section titled “How to Get Language Assistance.” Please see this section for complete instructions and phone numbers to request assistance.

Reminder. If You utilize an In-Network Provider, the Provider will send Us a claim on Your behalf. If You utilize an Out-of-Network Provider or Other Eligible ProviderProviders, the Provider may or may not file a claim on Your behalf. Member Cost Share For certain Covered Services, You may be required to pay all or a part of the Negotiated Fee Rate as Your Cost Share amount (Deductible, Copayment, and/or Coinsurance). See the SUMMARY OF BENEFITS and the section titled WHAT IS COVERED – MEDICAL for Your Cost Share responsibilities and limitations, or call Us at 1-855-Oscar-55 to learn how this Plan’s benefits or Cost Share amounts may vary by the type of Provider You use. Oscar will not provide any reimbursement for non-Covered Services. You may be responsible for the total amount billed by Your Provider for non-Covered Services, regardless of whether such services are performed by an In-Network Provider or Other Eligible Provider. Network Providers are prohibited by their contract with Us from billing or collecting from You for any services that are provided but denied because they are not Medically Necessary unless they obtain a written agreement from You wherein You agree to pay for such services. Out-of-Network Providers do not have a contract with Us and You will be responsible for the total amount billed by an Out-of-Network Provider for services that are denied because they are not Medically Necessary. Timely Access to Care We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. • Xxxxxx care appointments not requiring prior authorization may be obtained within forty-eight (48) hours of the request for an appointment appointment. • Xxxxxx care appointments requiring prior authorization may be obtained within ninety-six (96) hours of the request for an appointment appointment. • Non-urgent appointments for primary care may be obtained withinten within ten (10) business days of the request for an appointment appointment. • Non-urgent appointments with specialist physicians may be obtained within fifteenfifteen (15) business days of the request for appointment. • Non-urgent appointments with a non-physician mental health care provider may be obtained within ten (10) business days of the request for an appointment. • Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness or other health conditions may be obtained within fifteen (15) business days of the request for an appointment. • Telephone triage or screening service wait time shall not exceed thirty (30) minutes. The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with the professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the Members. Preventive care services, and periodic follow up care, including but not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. Xxxxx provides interpretation services, as described in the “Introduction” section titled “How to Get Language Assistance.” Please see this section for complete instructions and phone numbers to request assistance.

Reminder. If You utilize an In-Network Provider, the Provider will send Us a claim on Your behalf. If You utilize an Out-of-Network Provider or Other Eligible Provider, the Provider may or may not file a claim on Your behalf. Member Cost Share For certain Covered Services, You may be required to pay all or a part of the Negotiated Fee Rate as Your Cost Share amount (Deductible, Copayment, and/or Coinsurance). See the SUMMARY OF BENEFITS and the section titled WHAT IS COVERED – MEDICAL for Your Cost Share responsibilities and limitations, or call Us at 1-855-Oscar-55 to learn how this Plan’s benefits or Cost Share amounts may vary by the type of Provider You use. Oscar will not provide any reimbursement for non-Covered Services. You may be responsible for the total amount billed by Your Provider for non-Covered Services, regardless of whether such services are performed by an In-Network Provider or Other Eligible Provider. Network Providers are prohibited by their contract with Us from billing or collecting from You for any services that are provided but denied because they are not Medically Necessary unless they obtain a written agreement from You wherein You agree to pay for such services. Out-of-Network Providers do not have a contract with Us and You will be responsible for the total amount billed by an Out-of-Network Provider for services that are denied because they are not Medically Necessary. Timely Access to Care We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. • Xxxxxx care appointments not requiring prior authorization may be obtained within forty-eight (48) hours of the request for an appointment • Xxxxxx care appointments requiring prior authorization may be obtained within ninety-six (96) hours of the request for an appointment • Non-urgent appointments for primary care may be obtained withinten within ten (10) business days of the request for an appointment • Non-urgent appointments with specialist physicians may be obtained within fifteen

Reminder. If You utilize an In-Network Provider, the Provider will send Us a claim on Your behalf. If You utilize an Out-of-Network Provider or Other Eligible ProviderProviders, the Provider may or may not file a claim on Your behalf. Member Cost Share For certain Covered Services, You may be required to pay all or a part of the Negotiated Fee Rate as Your Cost Share amount (Deductible, Copayment, and/or Coinsurance). See the SUMMARY OF BENEFITS and the section titled part WHAT IS COVERED – MEDICAL for Your Cost Share responsibilities and limitations, or call Us at 1-855-Oscar-55 to learn how this Plan’s benefits or Cost Share amounts may vary by the type of Provider You use. Oscar will not provide any reimbursement for non-Covered Services. You may be responsible for the total amount billed by Your Provider for non-Covered Services, regardless of whether such services are performed by an In-Network Provider or Other Eligible Provider. Network Providers are prohibited by their contract with Us from billing or collecting from You for any services that are provided but denied because they are not Medically Necessary unless they obtain a written agreement from You wherein You agree to pay for such services. Out-of-of- Network Providers do not have a contract with Us and You will be responsible for the total amount billed by an Out-of-Network Provider for services that are denied because they are not Medically Necessary. Timely Access to Care We offer timely access for scheduling appointments with an In-Network physician, mental health professional and specialist for medical/surgical services, per state law. • Xxxxxx care appointments not requiring prior authorization may be obtained within forty-eight (48) 48 hours of the request for an appointment appointment. • Xxxxxx care appointments requiring prior authorization may be obtained within ninety-six (96) 96 hours of the request for an appointment appointment. • Non-urgent appointments for primary care may be obtained withinten (10) within 10 business days of the request for an appointment appointment. • Non-urgent appointments with specialist physicians may be obtained within fifteen15 business days of the request for appointment. • Non-urgent appointments with a non-physician mental health care provider may be obtained within ten business days of the request for an appointment. • Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness or other health conditions may be obtained within 15 business days of the request for an appointment. • Telephone triage or screening service wait time shall not exceed 30 minutes. The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the Member. Preventive care services, and periodic follow up care, including but not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. Xxxxx provides interpretation services, as described in the “Introduction” section titled “How to Get Language Assistance.” Please see this section for complete instructions and phone numbers to request assistance.