Special Rules For Using Certain Non-Network Providers At Network Facilities
(Regular Plan Only)

Starting April 1, 2004*, when you receive treatment at a network facility and your treating physician (that is, the physician who ordered your treatment at the facility) is a network provider, any eligible services you receive from non-network anesthesiologists, radiologists, pathologists and emergency room physicians will be paid at the network percentage of the reasonable and customary (R&C) charge. That means that once you've met the deductible**, you'll be responsible for the network coinsurance plus any amount over the R&C charge for each service.

However, if you go to a non-network facility, you may not take advantage of this special rule. That means you'll be responsible for a higher percentage of the cost (the non-network coinsurance) and any amount over the R&C limit.