Common use of Coverage Provided Clause in Contracts

Coverage Provided. Coverage under this Policy becomes effective on the Effective Date indicated on the face page of this Policy. To receive benefits from your coverage, you must use a Network Provider. However, payment will be made at the In-Network Provider level of benefits for services provided by an Out-of-Network Provider when the services are provided for an Emergency Medical Condition. We will provide you with a list of providers in your location via our website where you can locate an In-Network Provider that is right for you. Visit our website at xxxxxxxxxxxxxxxxxxxxxxxx.xxx/xxxx-x-xxxxxx. We have no obligation to advise you of the applicability of additional payment provisions for using an Out- of-Network Provider during the course of authorization prior to service or otherwise. You are responsible for choosing an In-Network Provider. If Medically Necessary covered services, excluding Emergency Services, are not available through one of our In-Network Providers we will approve a referral to an Out-of-Network Provider and issue payment to the Out-of-Network Provider at the Qualifying Paying Amount (QPA) as defined by Section 102 of the federal No Surprises Act. You will be held harmless for any amount beyond the copayment, deductible, and coinsurance percentage that you would have paid had you received services from an In-Network Provider.

Coverage Provided. Coverage under this Policy becomes effective on the Effective Date indicated on the face page of this Policy. To receive benefits from your coverage, you must use a Network Provider. However, payment will be made at the In-Network Provider level of benefits for services provided by an Out-of-Network Provider when the services are provided for an Emergency Medical Condition. We will provide you with a list of providers in your location via our website where you can locate an In-Network Provider that is right for you. Visit our website at xxxxxxxxxxxxxxxxxxxxxxxx.xxx/xxxx-x-xxxxxx. We have no obligation to advise you of the applicability of additional payment provisions for using an Out- of-Network Provider during the course of authorization prior to service or otherwise. You are responsible for choosing an In-Network Provider. If Medically Necessary covered services, excluding Emergency Services, are not available through one of our In-Network Providers we will approve a referral to an Out-of-Network Provider and issue payment to the Out-of-Network Provider at the Qualifying Paying Amount (QPA) as defined by Section 102 of the federal No Surprises Act. You will be held harmless for any amount beyond the copayment, deductible, and coinsurance percentage that you would have paid had you received services from an In-Network Provider.

Coverage Provided. Coverage under this Policy becomes effective on the Effective Date indicated on the face page of this Policy. To receive benefits from your coverage, you must use a Network Provider. However, payment will be made at the In-Network Provider level of benefits for services provided by an Out-of-Network Provider when the services are provided for an Emergency Medical Condition. We will provide you with a list of providers in your location via our website where you can locate an In-Network Provider that is right for you. Visit our website at xxxxxxxxxxxxxxxxxxxxxxxx.xxx/xxxx-x-xxxxxx. We have no obligation to advise you of the applicability of additional payment provisions for using an Out- of-Network Provider during the course of authorization prior to service or otherwise. You are responsible for choosing an In-Network Provider. If Medically Necessary covered services, excluding Emergency Services, are not available through one of our In-Network Providers we will approve a referral to an Out-of-Network Provider and issue payment to the Out-of-Network Provider at the Qualifying Paying Amount (QPA) as defined by Section 102 greater of a rate based on the requirements of state and federal No Surprises Actlaws. You will be held harmless for any amount beyond the copayment, deductible, and coinsurance percentage that you would have paid had you received services from an In-Network Provider. See the Notice of Surprise Billing section for additional information.