Common use of Your Cost Share Clause in Contracts

Your Cost Share. This plan has two levels of hospital benefits. You will pay a higher cost share when you receive certain inpatient services at or by “higher cost share hospitals”. See the chart on opposite page for cost share amounts. Please note: If your PCP refers you to another provider for covered services (such as a specialist), it is important to check whether the provideryouare referred to is affiliated withone of the higher cost share hospitals listed below. Your cost will be greater when you receive inpatient services at or by these hospitals, even if your PCP refers you.

Your Cost Share. This plan has two levels of hospital benefits. You will pay a higher cost share when you receive certain inpatient services at or by “higher cost share hospitals”. See the chart on opposite page for cost share amounts. Please note: If your PCP refers you to another provider for covered services (such services(such as a specialist), it is important to check whether the provideryouare referred to is affiliated withone of the higher cost share hospitals listed below. Your cost will be greater when you receive inpatient services at or by these hospitals, even if your PCP refers you.

Your Cost Share. This plan has two levels of hospital benefits. You will pay a higher cost share when you receive certain inpatient services at or by “higher cost share hospitals”t or by benefits. See .eferral froSee the chart on opposite page for cost share amounts. Please note: If your PCP refers you to another provider for covered services (such as a specialist), it is important to check whether the provideryouare provider youare referred to is affiliated withone with one of the higher cost share hospitals listed below. Your cost will be greater when you receive inpatient services at or by these hospitals, even if your PCP refers you.