Part 2 – Explanation of Terms (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 22 Primary Care Provider Your PPO health care network includes physicians (who are internists, family practitioners, or pediatricians), nurse practitioners, and physician assistants that you may choose to furnish your primary medical care. These health care providers are generally called primary care providers. As a member of this health plan, you are not required to choose a primary care provider in order for you to receive your health plan coverage. You may choose any covered provider to furnish your health care services and supplies. But, your choice is important because it will impact the costs that you pay for your health care services and supplies. Your costs will be less when you use health care providers who participate in your PPO health care network to furnish your covered services. Rider Blue Cross Blue Shield HMO Blue and/or your group (when you are enrolled in this health plan as a group member) may change the terms of your coverage in this health plan. If a material change is made to your coverage in this health plan, it is described in a rider. For example, a rider may change the amount that you must pay for certain services such as the amount of your copayment. Or, it may add to or limit the benefits provided by this health plan. Blue Cross Blue Shield HMO Blue will supply you with riders (if there are any) that apply to your coverage in this health plan. You should keep these riders with this Subscriber Certificate and your Schedule of Benefits so that you can refer to them. Room and Board For an approved inpatient admission, covered services include room and board. This means your room, meals, and general nursing services while you are an inpatient. This includes hospital services that are furnished in an intensive care or similar unit. Schedule of Benefits This Subscriber Certificate includes a Schedule of Benefits for your specific plan option. It describes the cost share amount that you must pay for each covered service (such as a deductible, a copayment, or a coinsurance). And, it includes important information about your deductible and out-of-pocket maximum. It also describes benefit limits that apply for certain covered services. Be sure to read all parts of this Subscriber Certificate and your Schedule of Benefits to understand your health care benefits. You should read the Schedule of Benefits along with the descriptions of covered services and the limits and exclusions that are described in this Subscriber Certificate. A rider may change the information that is shown in your Schedule of Benefits. Be sure to read each rider (if there is any). Service Area The service area is the geographic area in which you may receive all of your health care services and supplies. Your service area includes all counties in the Commonwealth of Massachusetts. In addition, for those members who are living or traveling outside of Massachusetts (but within the United States) this health plan provides access to the local Blue Cross and/or Blue Shield Plan’s PPO health care networks.