120 pay In - Network Providers for the geographic area where the service is provided for the same or similar services) or the amount billed by the Out - of - Network Air Ambulance service provider. • For all other Surprise Billing Claims, the Recognized Amount is the lesser of the Qualifying Payment Amount or the amount billed by the Out - of - Network Provider or Out - of - Network Facility; or the amount approved under an applicable All - Payer Model Agreement under section 1115A of the Social Secu rity Act. Recovery Please see the “Subrogation and Reimbursement” section for details. Residential Treatment Center / Facility: An Inpatient Facility that provides multidisciplinary treatment for Mental Health and Substance Use Disorder conditions. The Facility must be licensed as a residential treatment center in the state in which it is located , satisfy our accreditation requirements, and be approved by us The term Residential Treatment Center/Facility does not include a Provider, or that part of a Provider, used mainly for: 1. Nursing care 2. Rest care 3. Convalescent care 4. Care of the aged 5. Custodial Care 6. Educational care Retail Health Clinic A Facility that gives limited basic health care services to Members on a “walk - in” basis. These clinics are often found in major pharmacies or retail stores. Medical services are typically given by Physician Assistants and Nurse Practitioners. Service Area The geographical area where you can get Covered Services from an In - Network Provider. Skilled Nursing Facility An Inpatient Facility that provides multidisciplinary treatment for convalescent and rehabilitative care. It must be licensed as a skilled nursing facility in the state in which it is located, satisfy our accreditation requirements, and be approved by us. A Skilled Nursing Facility is not a place mainly for care of the aged, Custodial Care or domiciliary care, or a place for rest, educational, or similar services. Special Enrollment A period of time in which eligible people or their dependents can enroll after the initial enrollment, typically due to an event such as marriage, birth, adoption, etc. See the “Eligibility and Enrollment – Adding Members” section for more details. Specialist (Specialty Care Physician \ Provider or SCP)