Definitions for "Out-of-Network Benefits"
Keywords:  ppo, hmo, reimbursement, copays, pocket
Reimbursement for covered services provided by out-of-network providers and suppliers. Out-of-network benefits are generally subject to a deductible and coinsurance and, therefore, have higher out-of-pocket costs. Depending on your contract, out of network services may not be covered. Please refer to your contract for specific benefit coverage.
Covered services that are not provided, rendered or referred by your Primary Care Physician.
The benefits you receive when you use a health care provider who is not part of the network (out-of-network provider). Typically, you pay more when you use an out-of-network provider.