HOW YOUR COVERAGE WORKS. Your Agreement provides a wide range of coverage for health care services. The information contained in this section is designed to explain how You can access Your benefits. Xxxxx will cover up to the maximum described below for a Covered Service or supply. Review the SUMMARY OF BENEFITS, the sections titled WHAT IS COVERED – MEDICAL and WHAT IS COVERED – PRESCRIPTION DRUGS for information on Deductibles, Out of Pocket Maximums, Copayments/Coinsurance and any per day, Year or visit limits that may be applied to a particular benefit. Any limits on the number of visits or days covered are stated under the specific benefit and also listed in the SUMMARY OF BENEFITS. These benefits are subject to all other provisions of this Agreement as well, which may also limit benefits or result in benefits not being payable. This is an Exclusive Provider Organization (EPO) Plan. SERVICES MUST BE PERFORMED OR SUPPLIES FURNISHED BY AN IN-NETWORK PROVIDER IN ORDER FOR BENEFITS TO BE PAYABLE, UNLESS AND EXCEPTION APPLIES. There are no benefits provided when using an Out-of-Network Provider and You may be responsible for the total amount billed by an Out-of-Network Provider. The only exceptions are (1) services received by an Out-of- Network Provider as a result of a Medical Emergency, Urgent Care or as an Authorized Service as defined in DEFINITIONS; and (2) Covered Services received at an In-Network Facility, at which, or as a result of which, the Member receives Covered Services from an Out-of-Network Provider. Authorized Referrals and Covered Services received under the second exception are provided at in-network Cost-Sharing. You are responsible for confirming that the Provider You are seeing or have been referred to see is an In-Network Hospital or an In-Network Provider for this Plan. Any claims incurred from a Provider who is not an In-Network Provider under this Plan are considered Out-of-Network services and are not covered. You may be responsible for the total amount billed by an Out-of-Network Provider, even if You have been referred by another Oscar In-Network Provider, unless one of the exceptions listed above applies. Xxxxx can help You find an In-Network Hospital or In-Network Provider specific to Your Plan by calling customer service at 1-855-Oscar-55 or access Our website at xxx.xxxxxxx.xxx. Services offered by providers Some Hospitals and other Providers do not provide one or more of the following services that may be covered under Your Agreement and that Yo...
HOW YOUR COVERAGE WORKS. A. Your Coverage under this Policy. You have purchased a dental insurance Policy from Us. We will provide the benefits described in this Policy to You and/or Your covered Dependents. You should keep this Policy with Your other important papers so that it is available for Your future reference.
HOW YOUR COVERAGE WORKS. Coverage Under this Agreement. You have purchased a Group Health Plan from Us. We will provide the benefits described in the Plan Documents to covered Members of the Group, that is, to Your Eligible Employees and their covered dependents. You should keep this Agreement with other important papers so that it is available for future reference. You have a right to apply for any Group Health Plan contract written, issued, or administered by Oscar at the time of application for a new Group Health Plan contract, or at the time of renewal of a Group Health Plan contract. Oscar will provide, upon request, a listing of all contracts and benefit designs Oscar offers to Small Employers, including the rates for each contract.
HOW YOUR COVERAGE WORKS. A. Your Coverage under this Contract. You have purchased a dental insurance Contract from Us. We will provide the benefits described in this Contract to You and/or Your covered Dependents. You should keep this Contract with Your other important papers so that it is available for Your future reference.
HOW YOUR COVERAGE WORKS. A. Your Coverage under this Contract. You have purchased a vision insurance Contract from Us. We will provide the benefits described in this Contract to You and/or Your covered Dependents. You should keep this Contract with Your other important papers so that it is available for Your future reference.
HOW YOUR COVERAGE WORKS. Coverage Under this Agreement. You have purchased a Group Health Plan from Us. We will provide the benefits described in the Plan Documents to covered Members of the Group, that is, to Your Eligible Employees and their covered dependents. You should keep this Agreement with other important papers so that it is available for future reference. You have a right to apply for any Group Health Plan contract written, issued, or administered by Xxxxx at the time of application for a new Group Health Plan contract, or at the time of renewal of a Group Health Plan contract. Oscar will provide, upon request, a listing of all contracts and benefit designs Xxxxx offers to Small Employers, including the rates for each contract.
