A participating provider is contracted but is in another network. The plan pays these providers at the out-of-network rate (most covered services are paid at 60 percent), but the provider may not balance bill you.
Coinsurance paid to a participating provider applies to the out-of-pocket limit (for UMP Classic and UMP Plus, this is the medical out-of-pocket limit).
Covered preventive services from participating providers will be paid by the plan at 100 percent of the allowed amount. Covered mental health or substance use disorder services from participating providers will be considered in-network.
Note: For UMP Plus — if a participating provider is not in the core or support network, they will be considered out-of-network and services will be paid at the out-of-network rate.