Non-Plan Provider definition

Non-Plan Provider means a Provider that does not meet the definition of Plan Provider unless otherwise specified in the definition of a particular Provider.
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Non-Plan Provider means a Provider who does not have an independent contractor agreement with HPN.
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Non-Plan Provider means a Provider who does not have an independent contractor agreement with SHL.
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Examples of Non-Plan Provider in a sentence

  • Non-Plan Provider Services provided or arranged by criminal justice institutions for Members in the custody of law enforcement officers, unless the Services are covered as Out-of-Plan Emergency Services.

  • You are responsible for any Non-Plan Provider Emergency Service charges that exceed payments made by HPN.

  • Reimbursement for Covered Services approved by HPN and provided by a Non-Plan Provider outside HPN’s Service Area shall be limited to the average payment which HPN makes to Plan Providers in HPN’s Service Area.

  • When seeking reimbursement from HPN for expenses incurred in connection with services received from Non-Plan Providers, the Member must complete a Non-Plan Provider Claim Form and submit it to the HPN Claims Department with copies of all of the medical records, bills and/or receipts from the Provider.

  • Reimbursement for Covered Services provided by a Non-Plan Provider outside HPN’s Service Area to a newborn natural child or adopted child is limited to HPN’s Eligible Medical Expense for similar Covered Services provided in HPN's Service Area.

  • Members are responsible for any Non-Plan Provider Emergency Service charges that exceed payments made by the CO-OP.

  • Benefits are limited to Eligible Medical Expenses for Non-Plan Provider Emergency Services as defined under “HPN Reimbursement Schedule”.

  • Please see Attachment A Benefit Schedule for the annual Out-of-Pocket Maximums that apply separately to Plan Provider and Non-Plan Provider benefits.

  • If the Member receives a bill for Covered Services from a Non-Plan Provider, the Member may request that the CO-OP pay the Provider directly by sending the bill, with copies of all medical records and a signed completed Non-Plan Provider Claim Form, to the CO-OP Claims Department.

  • Benefits are limited to Eligible Medical Expenses for Non-Plan Provider Emergency Services as defined under “SHL Reimbursement Schedule”.


More Definitions of Non-Plan Provider

Non-Plan Provider means a Provider who does not have an independent contractor agreement with the CO-OP.
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Non-Plan Provider or "Out-of-network Provider" means a Provider who does not have an independent contractor agreement with LIBERTY.
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Non-Plan Provider or “Out-of-network Provider” means a Provider who does not have an
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Non-Plan Provider means a Provider that does not meet the definition of Plan Provider unless
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Non-Plan Provider means a Provider that does not meet the definition of Plan Provider unless otherwise specified in the definition of a particular Pro­ vider.
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Non-Plan Provider means a pharmacy or online retailer that isn’t a Plan Provider. To find out more about coverage and limitations, including the current list of Plan Providers, visit our website or call Member Services.
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Related to Non-Plan Provider

  • Plan Provider means a Provider which has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered to you.

  • 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.

  • Participating Provider means an Administrator Hospital or Professional Provider which has 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 an Administrator facility which has been designated by the Claim Administrator as a Participating Provider.

  • Common Service Provider means a person nominated by the ICSDs to perform the role of common service provider;

  • The Service Provider means the Bidder or firm supplying the Services under this Contract.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Education service provider means an education management organization, school

  • Non-Participating Prosthetic Provider means a Prosthetic Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Professional Provider means a Physician, Dentist, Podiatrist, Psychologist, Chiropractor, Optometrist or any Provider designated by the Claim Administrator or another Blue Cross and/or Blue Shield Plan.

  • Non-Participating Retail Health Clinic means a Retail Health Clinic which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Non-Participating Durable Medical Equipment Provider means a Durable Medical Equipment Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Terms-of-service agreement means an agreement that controls the relationship between a user and a custodian.