Out-of-Network Coverage

If you go out-of-network, you are still covered but are responsible for paying 70% of the Plan Allowance PLUS the difference between the Plan Allowance and the billed amount. The Plan Allowance is the maximum amount we will pay for a covered health care service; typically, the amount that providers we contract with have agreed to accept as payment in full. Out-of-network providers are not under a contract, meaning they have not agreed to a negotiated fee-for-services — so you will likely end up paying more.