In-network and Out-of-Network | Benefits | University Human Resources

Understanding In-Network and Out-of-Network Benefits

Using in-network providers is key to receiving the highest level of healthcare benefits. Services from a provider other than an in-network one are considered out-of-network, except for emergency or urgent care away from home.

In-network

In network refers to providers or health care facilities that are part of a health plan's network of providers with which it has negotiated a discount.

Deductibles, coinsurance, and out-of-pocket maximums are lower.
The member is not responsible for charges above the plan’s allowed amounts.
Preventive services are paid at 100%.
Services requiring approval are authorized in advance.

Out-of-network

Providers that are out-of-network are those that do not participate in that health plan's network. The provider is not contracted with the health insurance plan to accepted negotiated rates. This mean that patients will typically pay more or the full amount for the service they receive.

Deductibles, coinsurance, and out-of-pocket maximums are higher.
The member is responsible for charges above the plan’s allowed amount (called “balance billing”). These charges can be significant.
Preventive services are not paid at 100%.
Out-of-network providers are not required to authorize services in advance. The member may have to request authorization or risk being responsible for charges.