Limited Network definition
Examples of Limited Network in a sentence
Members should schedule such care while in Keystone’s Limited Network Area through regular appointments with their PCP.
Mail-Order/90-Day Limited Network Retail Pharmacy Solution for maintenance/preventive drugs: The member/dependent(s) will be required to use mail order or pick up prescriptions at an in-network retail pharmacy for all maintenance/preventive drugs needed for a long-term health condition.
Follow-Up Care must be pre-arranged and Preauthorized by the Member's Primary Care Physician in Keystone's Limited Network Area prior to leaving Keystone's Limited Network Area.
Subscribers who will be out of Keystone’s Approved Service Area for greater than six (6) months or who change their permanent residence to an address outside of Keystone’s Limited Network Area, are not eligible for the Guest Membership Program.
Emergency Services are covered whether they are provided inside or outside Keystone’s Limited Network Area.
Urgent Care Benefits cover Medically Necessary treatment for any unforeseen illness or injury that requires treatment prior to when the Member returns to Keystone's Limited Network Area.
The care must be needed for urgent ongoing treatment of an injury, illness, or condition that occurred while the Member was in Keystone's Limited Network Area.
Under the BlueCard Program, coverage is provided only for those specified, Preauthorized service(s) authorized by the Member's Primary Care Physician in Keystone's Limited Network Area and the HMO's Care Management and Coordination Department.
Keystone does not pay for routine care (such as physicals) or other non-Urgent Care provided outside of Keystone’s Limited Network Area.
Members will have a PCP both at the guest HMO and in Keystone’s Limited Network Area.