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Out-of-area services are health care services by providers located outside of the U.S. or in geographic areas where there is no access to a network provider under the mileage standards listed below.
Where there is no access to a network provider, the plan may pay a non-network provider at the "out-of-area" rate (80% of the allowed amount, after you've met your medical deductible). Non-network providers, even when paid at the out-of-area rate, can bill you for the difference between their billed charge and the allowed amount.
In the following cases, the plan may pay a non-network provider as out-of-area:
| For primary care services |
For specialist services |
| Urban: If network provider is not available within 30 miles of the enrollee's residence. |
Urban and Rural:
If a network provider is not available within 50 miles of the enrollee's residence. |
| Rural: If a network provider is not available within 50 miles of the enrollee's residence. |
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