Non-Participating Provider definition

Non-Participating Provider means a Plan Hospital or Professional Pro­ vider which does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to participants in a Participating Provider Option program or a fa­ cility which has not been designated by Blue Cross and Blue Shield of Illinois as a Participating Provider.
Non-Participating Provider means an Administrator Hospital or Professional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Participating Provider.
Non-Participating Provider means an Administrator Hospital or Pro­ fessional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide ser­ vices to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Par­ ticipating Provider.

Examples of Non-Participating Provider in a sentence

  • If payment is made to the Insured Person for services provided by a Non-Participating Provider, the Insured Person is responsible for paying the Non-Participating Provider and Our payment to the Insured Person will be considered fulfillment of Our obligation.

  • Payment for services provided by a Non-Participating Provider are payable to the Insured Person unless assignment is made as above.

  • Covered Services rendered in a Non-Plan Provider facility will be paid at the Non-Participating Provider facility payment level.

  • When you receive Covered Services from a Non-Participating Provider, you are responsible for:• the Copayment or Coinsurance (once any Calendar Year Deductible has been met), and• any charges above the Allowable Amount.

  • A Non-Participating Provider (Out of Network Provider) is a provider who does not have a Participating Provider agreement in effect with Cigna for this Policy at the time services are rendered.


More Definitions of Non-Participating Provider

Non-Participating Provider means a provider that does not have a contractual relationship with an MCE and is not on their panel of providers.
Non-Participating Provider means, for purposes of this Amendment only, with respect to a covered item or service, a physician or other health care provider who does not have a contractual relationship with BCBSMT for furnishing such item or service under the Contract to which this Amendment is attached.
Non-Participating Provider means a Hospital or Professional Provider that either: (i) does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield to provide services to participants in the benefit program, or; (ii) has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider in the benefit program.
Non-Participating Provider means a provider of medical care and/or services with which the Contractor has no Provider Agreement.
Non-Participating Provider. A Provider who doesn’t have a contract with Us to provide health care services to You. You will pay more to see a Non-Participating Provider. Out-of-Network Coinsurance: Your share of the costs of a Covered Service calculated as a percent of the Allowed Amount for the service that You are required to pay to a Non-Participating Provider. The amount can vary by the type of Covered Service. Out-of-Network Copayment: A fixed amount You pay directly to a Non-Participating Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Out-of-Network Deductible: The amount You owe before We begin to pay for Covered Services received from Non-Participating Providers. The Out-of-Network Deductible applies before any Copayments or Coinsurance are applied. The Out-of-Network Deductible may not apply to all Covered Services. You may also have an Out-of-Network Deductible that applies to a specific Covered Service (e.g., a Prescription Drug Deductible) that You owe before We begin to pay for a particular Covered Service. Out-of-Pocket Limit: The most You pay during a Plan Year in Cost-Sharing before We begin to pay 100% of the Allowed Amount for Covered Services. This limit never includes Your Premium, Balance Billing charges or the cost of dental care services We do not Cover. The Out-of-Pocket Limit only applies to benefits that are part of the pediatric dental essential health benefit.
Non-Participating Provider means a Dentist who is not a Participating Provider.
Non-Participating Provider means a provider that does not have a contractual relationship with a PHP or CCO and is not on their panel of providers.