Virtual Care Quick Reference 

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Use Network Providers to Get Quality Care at Lower Costs 

The Plan generally pays higher benefits for medical care 
if you choose an In-Network Provider than if you choose an Out-of-Network Provider. 
Network Providers discount their fees and agree to accept the “contracted rate” as payment for services. After you meet your Deductible, as applicable, your share of the cost for covered In-Network services is based on a percentage of this lower contracted rate. 

When you use an Out-of-Network Provider, the Plan Allowance will be used to determine the amount the 
Plan will consider in determining the benefits payable on your Claim, instead of the In-Network contracted amount. The Out-of-Network Provider can then bill you for any amount they charge that is above the Plan’s Allowance for a service. This is called “balance billing” and is your responsibility to pay. 

Please note: While Plan staff will do their best to answer any questions you have concerning the Plan’s Allowance for a particular service over the phone, you may not rely on any information obtained in that manner. Only information in writing signed on behalf of the Board of Trustees can be considered official.

Another advantage to using an In-Network Provider is that the In-Network Provider will usually file a Claim for benefits with the Plan on your behalf. If you choose an Out-of-Network Provider, you may have to pay the entire cost of your care up front, then file a Claim for benefits with the Plan in order to receive reimbursement of the Plan’s share of your covered care. 

Remember that just because you obtain care from an In-Network Provider, it does not mean all services are automatically covered. If you have questions regarding coverage for a particular procedure, treatment, diagnostic test or medical supply item, contact 
the Plan at (800) 777-4013.