32 How Your Plan Works Introduction 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 Plans 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 - 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