122 In-Network Provider A Provider that has a contract, either directly or indirectly, with us, or another organization, to give Covered Services to Members through negotiated payment arrangements. A Provider that is In-Network for one plan may not be In-Network for another. Please see “How to Find a Provider in the Network” in the section “How Your Plan Works” for more information on how to find an In-Network Provider for this Plan. There are different levels of In-Network Providers. A Tier 1 Provider charges lower Copayments / Coinsurance on many services than Tier 2 Providers. Inpatient A Member who is treated as a registered bed patient in a Hospital and for whom a room and board charge is made. Intensive In-Home Behavioral Health Program A range of therapy services provided in the home to address symptoms and behaviors that, as the result of a Mental Disorder or Substance Use Disorder, put the Members and others at risk of harm. Intensive Outpatient Program Structured, multidisciplinary treatment for Mental Health and Substance Use Disorders that provides a combination of individual, group and family therapy to Members who require a type or frequency of treatment that is not available in a standard outpatient setting. Late Enrollees Subscribers or Dependents who enroll in the Plan after the initial enrollment period. A person will not be considered a Late Enrollee if he or she enrolls during a Special Enrollment period. Please see the “Eligibility and Enrollment – Adding Members” section for further details. Maximum Allowed Amount The maximum payment that we will allow for Covered Services. For more information, see the “EXPERIMENTAL OR INVESTIGATIONAL SERVICES EXCLUSION Any Drug, biologic, device, diagnostic, product, equipment, procedure, treatment, service, or supply, used in or directly related to the diagnosis, evaluation, or treatment of a disease, injury, illness, or other health problem which is determined to be Experimental or Investigational is not covered by your Plan. The Plan will deem any Drug, biologic, device, Diagnostic, product, equipment, procedure, treatment, service, or supply to be Experimental or Investigational if determined that one of more of the criteria listed below apply when the service is rendered with respect to the use for which benefits are sought. The Drug, biologic, device, Diagnostic, product, equipment, procedure, treatment, service, or supply: • cannot be legally marketed in the United States without the final approval of the Food and Drug Administration (FDA), or other licensing or regulatory agency, and such final approval has not been granted; • has been determined by the FDA to be contraindicated for the specific use; or • is subject to review and approval of an Institutional Review Board (IRB) or other body serving a similar function; or • is given because of informed consent documents that describe the Drug, biologic, device, Diagnostic, product, equipment, procedure, treatment, service, or supply as Experimental or Investigational, or