Common use of Accessing Care Clause in Contracts

Accessing Care. 1. Members are entitled to Covered Services from the following: • Your Provider Network is KFHPWAO’s Access PPO Preferred Provider Network, referred to as “PPN”. o Standard in-network benefits apply to any Preferred Provider o Enhanced in-network benefits apply when a Members utilizes designated integrated providers (Xxxxxx Permanente Medical Centers and providers or other designated providers as identified in the Provider Directory). These providers provide services at the lowest cost share as stated in Section IV. • Care provided by an Out-of-Network Provider, except prescription drugs. Coverage provided by an Out-of-Network Provider is limited to the Allowed Amount. o Out-of-Country providers are limited to a provider who meets licensing and certification requirements established where the provider practices. Benefits paid under one option will not be duplicated under the other option.