Covered Services

Covered Services

 

You have the right to the coverage described in this part, except as limited or excluded in other parts of this benefit booklet. Also, be sure to read your Schedule of Benefits. It describes the cost share amounts that you must pay for covered services. And, it shows the benefit limits that apply to specific covered services. (Also refer to riders—if there are any—that apply to your coverage in this health plan.) Your coverage in this health plan consists of two benefit levels: one for in-network benefits; and one for out-of-network benefits. This means that your cost share amount differs based on the benefit level of the covered services that you receive. The highest benefit level is provided when you receive covered services from a covered provider who participates in your PPO health care network. This is your in-network benefit level. The lowest benefit level is usually provided when you receive covered services from a covered provider who does not participate in your PPO health care network. This is your out-of-network benefit level. Your Schedule of Benefits shows the cost share amounts that you will pay for in-network benefits and for out-of-network benefits.