Common use of Subscriber Liability Calculation Clause in Contracts

Subscriber Liability Calculation. When covered health care services are provided outside of our service area by nonparticipating providers, the amount you pay for such services will normally be based on either the Host Blue’s nonparticipating provider local payment or the pricing arrangements required by applicable state law. In these situations, you may be responsible for the difference between the amount that the nonparticipating provider bills and the payment we will make for the covered health care services as set forth in this paragraph. Federal or state law, as applicable, will govern payments for out-of-network emergency services.

Subscriber Liability Calculation. When covered health care services are provided outside of our service area by nonparticipating providers, the amount you pay for such services will normally be based on either the Host Blue’s nonparticipating provider local payment or the pricing arrangements required by applicable state law. In these situations, you may be responsible for the difference between the amount that the nonparticipating provider bills and the payment we will make for the covered health care services as set forth in this paragraph. Federal or state law, as applicable, will govern payments for out-of-of- network emergency services.