Examples of Enrolled Member in a sentence
Enrolled Member liability calculation will be based on the negotiated price (refer to the description of negotiated price under Section 8.4.1, BlueCard Program) that the Host Blue makes available to BCBSRI that allows GROUP Enrolled Members access to negotiated participation agreement networks of specified participating healthcare providers outside of BCBSRI service area.
Where a reference benefit limit exceeds either a negotiated price or a provider’s billed charge, the Enrolled Member will incur no additional liability, other than any applicable Enrolled Member cost sharing.
BCBSRI shall protect the personal information pertaining to an Enrolled Member as required by Massachusetts Regulation 201.
Under this Arrangement, when Enrolled Member access covered healthcare services within the geographic area served by a Host Blue, the Host Blue will be responsible for contracting and handling all interactions with its participating healthcare providers.
As such, when Enrolled Member receive care from providers outside the BlueCard service area, the Enrolled Members will typically have to pay the providers and submit the claims themselves to obtain reimbursement for these services.