79 In t e r - P lan A rr an g emen t s E ligi b ili t y – C l aim T y p es Most c l a i m t y p e s are e l i g i b l e t o b e pro c e ss ed t hrou g h I n t e r - Pl a n A rr a n g e m e n t s , a s d e scr i b e d a b o v e. Examples of claims that are not included are Prescription Drugs that you obtain from a Pharmacy and most dental or vision benefits. A . Blue C a r d ® Pr og r am Und e r t he B l u e Ca r d ® P r o gra m , w h e n y o u re c e i v e Covered Services w i t h i n t he g e o gr a p hi c ar e a ser v ed b y a H o s t Bl u e, we w i l l still fulfill our contractual obligations. But, the Host Blue is responsible for: (a) contracting with its Providers; and (b) handling its interactions with those Providers. W h en y ou re c e i v e Covered Services o u t s i de the Anthem Service Area a nd t he cl a i m i s pro c e ss ed t h r o u gh t he B l u e Card P r o gra m , t he a m o u nt y o u p a y i s c a l c u l a t ed b a s ed on t he l o wer o f : • T he b i l l e d ch a r g es f or Co v er e d S er v i c e s ; or • T he n e g o t i a t ed price t h at th e H o s t Bl u e m a k es a v a i l a b l e t o Us. O f te n , t hi s “n e g o t i a t ed price” wi l l b e a s i m p l e di sc o u nt th a t re f l e c ts a n a c t u al price th a t t he H o s t Bl u e p a y s t o the Provider . S o m et i m e s , i t i s an est i m at e d p r i c e t h at ta k es i nto ac c o u nt s p e c i al ar r a n g e m e n ts w i th that Provider. Sometimes, such an arrangement may be an average price, based on a discount that results in expected average savings for services provided by similar types of Providers. Estimated and average pricing arrangements may also involve t y p e s of s et tl e m e n t s , i n c e nt i v e p a y m e n ts a n d/ o r o t h er cr e di ts or c h a r g e s . E s t i m at e d p r i c i ng a n d a v e r a g e pric i n g a l s o t a k e i n to a cc o u nt a d j u s t m e n ts to c or r e c t f or o v e r - or u n d e r e s t i m at i on of p a s t pr i c i ng of c l a i m s , a s n o t e d a b o v e . H o w e v er, s u c h a d j u s t m e n ts w i l l n ot a ff e c t t h e p r i c e we u s e d f or y o u r cl a i m b e c a u s e t h e y w i l l n ot b e a p p li e d a f ter a c l a i m h a s a l r e a d y b e e n p a i d. B. S p e ci a l Ca s es: V alue - Bas e d Pr o g r ams Bl u eCard ® P r o gram If y o u r e c e i v e Covered Services u n d er a V a l u e - B a s ed P r o g r am i n s i d e a Ho s t Bl u e ’ s S e r vi c e Area, y o u w il l n o t b e re s p o n s i b l e f or p a y i ng an y of t h e P r o v i d er Ince n t i v e s , ris k - s h a r i n g , a n d/ o r Care Co o r d i n at o r F e es t h at are a p a r t of s u c h an a rr a n g e m e n t, e xc e p t w h en a Ho s t B l ue p a ss es t h e s e f e e s to Anthem throu g h a v er a ge pr i c i ng or f ee sc h e d u l e a d j u s t m e n t s . A d d i t i o n al i n f or m at i on i s a v a i l a b l e u p on r e q u e s t . C. In t e r - P l an P r og r a m s: Fede r a l / S t ate T a x e s / S u r c ha r ge s / F e e s Fe d er a l or s ta t e l a w s or r e g u l a t i o ns m a y re q u i r e a s ur c h a r g e , tax or o th e r f ee . If a p p li c a b l e , we w i l l i n cl u d e a n y s u c h s ur c h a r g e , t a x or ot h er f ee as p a r t o f t h e c l a i m c h a r ge p a ss ed o n t o y o u. D. N o np a r t ic i pati n g Pr o vi de r s O ut side Our S e r v ice A re a 1. Allowed Amounts and Member Liabili t y C a l culati o n When Covered Services are provided outside of Anthem ’s Service Area by non - participating providers, the Plan may determine benefits and make payment based on pricing from either the Host Blue or the pricing arrangements required by applicable state or federal law. In these situations, the amount you pay fo r such services as Deductible, Copayment or Coinsurance will be based on that allowed amount. Also, you may be responsible for the difference between the amount that the non - participating provider bills and the payment we will make for the Covered Services as set forth in this paragraph. Federal or state law, as applicable, will govern payments for Out - of - Network Emergency services.