31 How Your Plan Works Introduction Your Plan is a PPO plan. The Plan has two sets of benefits: In - Network and Out - of - Network. If you choose an In - Network Provider, you will pay less in Out - of - Pocket costs, such as Copayments, Deductibles, and Coinsurance. If you use an Out - of - Network Pr ovider, you will have to pay more Out - of - Pocket costs. To find an In - Network Provider for this Plan, please see “How to Find a Provider in the Network,” later in this section. In - Network Services When you use an In - Network Provider or get care as part of an Authorized Service, Covered Services will be covered at the In - Network level. If you receive Covered Services from an Out - of - Network Provider after we failed to provide you with accurate information in our Provider Directory, or after we failed to respond to your telephone or web - based inquiry within the time required by federal law , your cost share for Covered Services will be based on the In - Network level. Regardless of Medical Necessity, benefits will be denied for care that is not a Covered Service. We, on behalf of the Employer, have final authority to decide the Medical Necessity of the service. In - Network Providers include Primary Care Physicians / Providers (PCPs), Specialists (Specialty Care Physicians / Providers - SCPs), other professional Providers, Hospitals, and other Facilities who contract with us to care for you. Referrals are never needed to visit an In - Network Specialist, including behavioral health Providers. To see a Doctor, call their office: • Tell them you are an Anthem Member, • Have your Member Identification Card handy. The Doctor’s office may ask you for your group or Member ID number. • Tell them the reason for your visit. When you go to the office, be sure to bring your Member Identification Card with you. If you need to see a Specialist, you can visit any In - Network Specialist including a behavioral health Provider. You do not have to get a Referral. For services from In - Network Providers: 1. You will not need to file claims. In - Network Providers will file claims for Covered Services for you. (You will still need to pay any Coinsurance, Copayments, and/or Deductibles that apply.) You may be billed by your In - Network Provider(s) for any non - C overed Services you get or when you have not followed the terms of this Booklet. 2. Precertification will be done by the In - Network Provider. (See the “ Getting Approval for Benefits ” section for further details.) Please read the “Claims Payment” section for additional information on Authorized Services.