Co-payment Limits and Member Charges For Noncovered Services. No deductibles or co- payments are permitted for covered services unless specified by plan design. Provider must inform Members of the costs for non-covered services prior to rendering such services and must obtain a signed private pay formfrom such a Member. Provider is responsible for collection at the time of service any applicable CHIP co-payments or deductibles in accordance with CHIP cost-sharing limitations. Co-payments are the only amounts Providers may collect from CHIP Members except the costs associated with unauthorized non-emergency serviced provided to a Member by out-of- network providers for non-covered services. For purposes of this section noncovered services are services not covered under the plan, services which are provided in the absence of appropriate authorization and services which are provided out-of-network unless otherwise specified in the contract, policy or regulation (e.g., family planning, mental health or emergency room services). Provider shall not charge cost-sharing or deductibles to CHIP Members of Native American Tribes or Alaskan Natives, co-payments or deductibles to a CHIP Member with and ID card that indicates the Member has met his or her –cost-sharing obligation for the balance of their term of coverage and co-payments for well-child or well-baby visits or immunizations.