Examples of Level of Benefits in a sentence
Out-of-Plan Level of Benefits (Care from Out-of-Plan Providers)Under the Plan, you may also use providers who do not participate with HNE.
Summary Chart In-Plan Level of Benefits (Care from In-Plan Providers)When you use Plan Providers, you will not have to submit claim forms.
In-Plan Level of Benefits (Care from In-Plan Providers)When you use Plan Providers, you will not have to submit claim forms.
Remember, in order to receive Covered Services at the Authorized Level of Benefits, you must receive care from or authorized by your Tufts HP PCP.
You should verify that the physician you will be seeing participates as an In-Plan Provider Out-of-Plan Level of Benefits (Care from Out-of-Plan Providers)Under the Plan, you may also use providers who do not participate with HNE.
Important Note about your coverage under the Affordable Care Act (“ACA”): Under the ACA, preventive care services -- including women’s preventive health services, certain prescription medications, and certain over-the-counter medications when prescribed by a licensed Provider and dispensed at a pharmacy pursuant to a prescription – received at the Authorized Level of Benefits are covered in full.
To get the highest Level of Benefits, You must get Your prescription from an AultCare Participating Network Pharmacy.
You will receive the reduced Out-of-Network Level of Benefits (described in the Schedule of Benefits) for all other Covered Medical Services with some exceptions.
To determine whether your Durable Medical Equipment benefit is subject to Member Cost Sharing at the Unauthorized Level of Benefits, please see the “Benefit Overview” section earlier in this Member Handbook or call Member Services at 800-870-9488.
Note: You may be responsible for paying a Deductible or Coinsurance towards the cost of Durable Medical Equipment covered at the Unauthorized Level of Benefits.