Common use of Out of Network Clause in Contracts

Out of Network. If you wish to visit a provider who does not participate with the plan, you’ll still be covered for designated services after meeting a deductible and paying coinsurance. Non-participating providers also may charge you for any balance above the maximum allowable amount. Individual deductible: $1,000 Family deductible: $2,000 (2-member family); $2,000 (family of 3 or more) Coinsurance: 30% after deductible, up to the cost-share maximum. Lifetime maximum: In-Network: Unlimited Out-of-network: $1,000,000 per member Managed Benefits: Precertification is required for hospital admissions, certain elective surgical procedures; and other services as specified by the Plan. Members are responsible for obtaining pre-certification for the required services.

Out of Network. If you wish to visit a provider who does not participate with the plan, you’ll still be covered for designated services after meeting a deductible and paying coinsurance. Non-participating providers also may charge you for any balance above the maximum allowable amount. Individual deductible: $1,000 200 Family deductible: $2,000 400 (2-member family); $2,000 500 (family of 3 or more) Coinsurance: 3020% after deductible, up to the cost-share maximum. Lifetime maximum: In-Network: Unlimited Out-of-network: $1,000,000 per member Managed Benefits: Precertification is required for hospital admissions, certain elective surgical procedures; and other services as specified by the Plan. Members are responsible for obtaining pre-certification for the required services.