12 Schedule of Benefits In this section you will find an outline of the benefits included in your Plan and a summary of any Deductibles, Coinsurance, and Copayments that you must pay. Also listed are any Benefit Period Maximums or limits that apply. Please read the " Whats Covered " and Prescription Drugs section(s) for more details on the Plans Covered Services. Read the Whats Not Covered section for details on Excluded Services. All Covered Services are subject to the conditions, Exclusions, limitations, and terms of this Booklet including any endorsements, amendments , or riders. To get the maximum benefits at the lowest Out - of - Pocket cost, you must get Covered Services from a Tier 1 In - Network Provider. Covered Services received from any other Network Provider are covered at Tier 2 Network level and often require a higher Copayment / Coinsurance. Services which are not received from a Tier 1 or Tier 2 Provider will be considered a Tier 3 Out - of - Network s ervice, unless otherwise specified in this Booklet. To get the highest benefits at the lowest Out - of - Pocket cost, you must get Covered Services from an In - Network Provider. Benefits for Covered Services are based on the Maximum Allowed Amount, which is the most the Plan will allow for a Covered Service. Except for Surprise Billing Claims, when you use an Out - of - Network Provider you may have to pay the difference between the Out - of - Network Providers billed charge and the Maximum Allowed Amount in addition to any Coinsurance, Copayments, Deductibles, and non - covered charges. This amount can be substantial. Ple ase read the