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 “ 119
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