Common use of Out-of-Network Providers Clause in Contracts

Out-of-Network Providers. In spending POWER Account funds, enrollees will be permitted to pay for the following covered services, even if obtained through out-of- network providers: i. Family planning services; ii. Emergency medical services, subject to the prudent layperson standard of an “emergency medical condition,” as specified in 42 CFR 438.114; iii. Medically necessary covered services, if the MCO’s network is unable to provide the service within a 30-mile radius for primary care and a 60-mile radius for specialty care of the enrollee’s residence; and iv. Nurse practitioner services.