33 Your Plan is a Point of Service (POS) 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 Provider, 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. This Plan includes three (3) levels of coverage: • Tier 1 Network Providers contract with the Plan and charge a lower Copayment / Coinsurance on many services than other In-Network Providers. • Tier 2 All other Network Providers are also In-Network but may require a higher Copayment/Coinsurance on many services than Tier 1 In-Network Provider. • Out-of-Network Providers are not in the Plan’s Network and require the highest Copayment / Coinsurance in this Benefit Booklet. 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-Covered 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 “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