As a participant in the OU Plan, you will have the opportunity to choose which Professional Providers you want to provide your care. Some providers you may choose will be part of a network of providers who have agreements with the Plan to accept certain payment for services. These are called in-network providers. Those Professional Providers who do not have agreements with the Plan to accept certain payment for services are referred to as out-of-network providers. You or your dependents may choose either for your medical care. However, your out-of-pocket costs will differ depending upon which provider you choose.

Choosing an In-Network Provider. If you choose to obtain care from one of the Plan’s participating (innetwork) providers, the allowance that the Plan pays to the provider, along with any required patient deductibles, co-pay or co-insurance, is usually considered payment in full.

Choosing an Out-of-Network Provider. However, if you choose or for some reason are required to obtain care or services from a non-participating provider, you are responsible for any deductibles, copayments and out-of-pocket maximums, as well as any charges that exceed the U&C allowances. Please keep in mind that the Plan offers as large a network as possible; however, it cannot guarantee that all hospitals, providers and pharmacies that you use will be “in-network”; nor can it guarantee that all geographic locations in which you may choose to live or to which you may travel will have in-network providers for you to utilize. If you are concerned about whether the provider you choose has an agreement with the Plan for payment, you should inquire before you see the provider.