Orange County NC Website
21 <br /> SECTION IV. <br /> HEALTH SERVICES COVERED BY THE PLAN <br /> The Plan will cover a wide range of Medically Necessary Health <br /> Services because we want to keep Members as healthy as possible. There <br /> are limits to Covered Health Services, however, and some types of care <br /> are not Covered at all. The following Subsection lists the Health <br /> Services Covered by the Plan. <br /> When a Member arrives at a Participating Physician or <br /> Participating Provider to receive Covered Health Services, they must <br /> show the Physician or Provider their Membership Card so they know that <br /> the Member is covered by the Plan. The Plan will only pay for Medically <br /> Necessary Health Services from Participating Physicians and <br /> Participating Providers except in the case of an Emergency or when the <br /> Member's Personal Physician sends that Member to non-participating <br /> physician or provider with the Plan's prior written, approval. Members <br /> have a wide choice of Participating Physicians and Participating <br /> Providers, but their right to choose is not unlimited. <br /> Members may have to pay part of the bill for some Health <br /> Services, called a "Copayment" charge. The Copayments required for <br /> various Health Services are listed on pages 18-22 of this Contract. If <br /> • a Member is covered by another Group Benefit Plan which does not require <br /> Copayments, it may pay the part of the bill not covered by the Plan. <br /> 17 <br />