Out of Network Services

2009

Out-of-Network Medical Services:
Out-of-Network medical services are not covered in the HIP VIP Plans unless provided for emergency care, out of area urgent care or out of area renal (kidney) dialysis, unless approved by the Plan.

Out-of-Network Prescription Drug Coverage:
Generally, HIP only covers drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. Covered Part D drugs are available at Out-of-Network pharmacies in special circumstances including illness while traveling outside of the plan's service area where there is no network pharmacy.

In addition to paying the applicable copayments / coinsurances, you will be required to pay the difference between what HIP would pay for a prescription filled at an in-network pharmacy and what the Out-of-Network pharmacy charged for your prescriptions.

Before you fill a prescription at an out-of-network pharmacy, please call Customer Service to see if there is a network pharmacy available.

For Additional Information:

Since there are differences in plan design and covered benefits among the various HIP Medicare Products, please see the applicable Evidence of Coverage (contract) and Summary of Benefits for more information.

Pending CMS approval

H3330_H07_200d u/f 10/07