Non-Participating Provider means an Administrator Hospital or Professional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Participating Provider.
Non-Participating Provider means a Plan Hospital or Professional Pro vider which does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to participants in a Participating Provider Option program or a fa cility which has not been designated by Blue Cross and Blue Shield of Illinois as a Participating Provider.
Non-Participating Provider means an Administrator Hospital or Pro fessional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide ser vices to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Par ticipating Provider.
Examples of Non-Participating Provider in a sentence
The following services when furnished by a Participating Provider or Non-Participating Provider are not considered covered charges during the waiting period shown in the Schedule of Benefits: Group II Services The services shown above are not covered charges under this Policy, and cannot be used to meet this Policy’s Deductibles.
You must also pay any charges of a Non-Participating Provider that are in excess of the Allowed Amount.
However, if You receive services from a Non-Participating Provider; either You or the Provider must file a claim form with Us. If the Non-Participating Provider is not willing to file the claim form, You will need to file it with Us.
Any charges of a Non-Participating Provider that are in excess of the Allowed Amount do not apply towards the Deductible.
More Definitions of Non-Participating Provider
Non-Participating Provider means, for purposes of this Amendment only, with respect to a covered item or service, a physician or other health care provider who does not have a contractual relationship with BCBSMT for furnishing such item or service under the Contract to which this Amendment is attached.
Non-Participating Provider means a provider of medical care and/or services with which the Contractor has no Provider Agreement.
Non-Participating Provider means, for purposes of this section only, with respect to a covered item or service, a Physician or other health care provider who does not have a contractual relationship with BCBSMT for furnishing such item or service under The Plan.
Non-Participating Provider means a provider that does not have a contractual relationship with an MCE and is not on their panel of providers.
Non-Participating Provider means a Hospital or Professional Provider that either: (i) does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield to provide services to participants in the benefit program, or; (ii) has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider in the benefit program.
Non-Participating Provider. A Provider who doesn’t have a contract with Us to provide health care services to You. You will pay more to see a Non-Participating Provider. Out-of-Network Coinsurance: Your share of the costs of a Covered Service calculated as a percent of the Allowed Amount for the service that You are required to pay to a Non-Participating Provider. The amount can vary by the type of Covered Service. Out-of-Network Copayment: A fixed amount You pay directly to a Non-Participating Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Out-of-Network Deductible: The amount You owe before We begin to pay for Covered Services received from Non-Participating Providers. The Out-of-Network Deductible applies before any Copayments or Coinsurance are applied. The Out-of-Network Deductible may not apply to all Covered Services. You may also have an Out-of-Network Deductible that applies to a specific Covered Service (e.g., a Prescription Drug Deductible) that You owe before We begin to pay for a particular Covered Service. Out-of-Pocket Limit: The most You pay during a Plan Year in Cost-Sharing before We begin to pay 100% of the Allowed Amount for Covered Services. This limit never includes Your Premium, Balance Billing charges or the cost of dental care services We do not Cover. The Out-of-Pocket Limit only applies to benefits that are part of the pediatric dental essential health benefit.
Non-Participating Provider means a Dentist who is not a Participating Provider.