Common use of Payment for In Clause in Contracts

Payment for In. Area Emergency Treatment Benefits for emergency treatment received in your Participating IPA's/Participating Medical Group's treatment area will be paid at 100% of the Provider's Charge. However, each time you receive emergency treatment in a Hospital emergency room, you will be responsible for a Copayment of $100. Should you be admitted to the Hospital as an Inpatient, benefits will be paid as explained in the HOSPITAL BENEFITS and PHYSICIAN BENEFITS sections of this Certificate. If you are admitted to the Hospital as an Inpatient immediately following emergency treatment, the emergency room Copayment will be waived. Emergency services received for the treatment of criminal sexual assault or abuse will be paid at 100% of the Provider’s Charge. Benefits will not be subject to any deductible, Coinsurance, and/or Copayment. OUT‐OF‐AREA TREATMENT OF AN EMERGENCY If you are more than 30 miles away from your Participating IPA/Participating Medical Group and need to obtain treatment for an Emergency Medical Condition, benefits will be provided for the Hospital and Physician services that you receive. Benefits are available for the initial treatment of the emergency and for related follow‐up care but only if it is not reasonable for you to obtain the follow‐up care from your Primary Care Physician or Woman's Principal Health Care Provider. Payment for Out‐of‐Area Emergency Treatment Benefits for emergency treatment received outside of your Participating IPA's/Participating Medical Group's treatment area will be paid at 100% of the Provider's Charge. However, each time you receive emergency treatment in a Hospital emergency room, you will be responsible for a Copayment of $100. Should you be admitted to the Hospital as an Inpatient, benefits will be paid as explained in the HOSPITAL BENEFITS and PHYSICIAN BENEFITS sections of this Certificate. If you are admitted to the Hospital as an Inpatient immediately following emergency treatment, the emergency room Copayment will be waived. Emergency services received for the treatment of criminal sexual assault or abuse will be paid at 100% of the Provider’s Charge. Benefits will not be subject to any deductible, Coinsurance, and/or Copayment. Benefits for emergency ambulance transportation are available when:

Payment for In. Area Emergency Treatment Benefits for emergency treatment received in your Participating IPA's/Participating Medical Group's treatment area will be paid at 100% of the Provider's Charge. However, each time you receive emergency treatment in a Hospital emergency room, you will be responsible for a Copayment of $10075. Should you be admitted to the Hospital as an Inpatient, benefits will be paid as explained in the HOSPITAL BENEFITS and PHYSICIAN BENEFITS sections of this Certificate. If you are admitted to the Hospital as an Inpatient immediately following emergency treatment, the emergency room Copayment will be waived. Emergency services received for the treatment of criminal sexual assault or abuse will be paid at 100% of the Provider’s Charge. Benefits will not be subject to any deductible, Coinsurance, and/or Copayment. OUT‐OF‐AREA TREATMENT OF AN EMERGENCY If you are more than 30 miles away from your Participating IPA/Participating Medical Group and need to obtain treatment for an Emergency Medical Condition, benefits will be provided for the Hospital and Physician services that you receive. Benefits are available for the initial treatment of the emergency and for related follow‐up care but only if it is not reasonable for you to obtain the follow‐up care from your Primary Care Physician or Woman's Principal Health Care Provider. Payment for Out‐of‐Area Emergency Treatment Benefits for emergency treatment received outside of your Participating IPA's/Participating Medical Group's treatment area will be paid at 100% of the Provider's Charge. However, each time you receive emergency treatment in a Hospital emergency room, you will be responsible for a Copayment of $10075. Should you be admitted to the Hospital as an Inpatient, benefits will be paid as explained in the HOSPITAL BENEFITS and PHYSICIAN BENEFITS sections of this Certificate. If you are admitted to the Hospital as an Inpatient immediately following emergency treatment, the emergency room Copayment will be waived. Emergency services received for the treatment of criminal sexual assault or abuse will be paid at 100% of the Provider’s Charge. Benefits will not be subject to any deductible, Coinsurance, and/or Copayment. Benefits for emergency ambulance transportation are available when: