| Example: In-Network Provider |
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| Example of how we pay benefits when you use an in-network provider |
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Example:
In-network provider’s charge for a service
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$50.00 |
Amount allowed to an in-network provider (contracted amount)
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$45.00 |
The amount OMIP will pay to the in-network provider
(80% of $45.00, approved amount)
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$36.00 |
Your responsibility would be
(20% of $45.00, approved amount)
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$ 9.00 |
Total the in-network provider receives
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$45.00 |
The in-network provider would write off the $5.00 difference between the amount billed and the amount allowed for the service.
This is only an example. They assume that you have met any applicable deductible, but have not met the maximum out-of-pocket limit. The actual benefits of the Contract you choose will vary. You will need to read your actual Contract to determine how your benefits under the Contract will be paid.
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