Benefits Under the Plan Sample Clauses

Benefits Under the Plan. Benefits apply when Covered Services are provided by the Member’s Primary Care Physician or obtained from other Plan Providers with prior authorization by the Primary Care Physician. Except for Emergency Services, Urgent Care Services, OB/GYN visits or for a referral to a Specialist or Non−physician Specialist who is not a Plan Provider, services must be provided or arranged by the Member's Primary Care Physician and obtained from a Plan Provider. Benefit payments are based on the Allowed Benefit as determined by the Plan for various types of services and providers. The benefit payment is made directly to the Plan Physician or Plan Provider and is accepted as payment in full, except for any applicable Deductible, Copayment or Coinsurance amounts stated in the Schedule of Benefits. The Member is responsible for any applicable Deductible, Copayment or Coinsurance and the Plan Physician or Plan Provider may ▇▇▇▇ the Member directly for such amounts. This Agreement does not provide benefits for services provided by Non−Plan Providers except for Emergency Services and Urgent Care Services as set forth in this Agreement. However, if the Member has obtained a referral from a Plan Provider to obtain services from a Non−Plan Provider, for example, if a Plan Provider is not available to provide the service, payment will be issued in accordance with Section 19−710.1 of the Health General Article. The payment will be issued to either the Member or the Non−Plan Provider and is considered to be payment in full, except for any applicable Deductible, Copayment or Coinsurance amounts stated in the Schedule of Benefits.