Part 8 – Other Health Plan Provisions (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 83 Services Furnished by Non-Preferred Providers As a member of this health plan, you will usually receive the highest benefit level (your in-network benefits) only when you obtain covered services from a covered provider who participates in your PPO health care network. There are a few times when this health plan will provide in-network benefits for covered services you receive from a covered provider who does not participate in your PPO network. These times are described below in this section. If you receive covered services from a covered provider who does not participate in your PPO health care network, you will receive in-network benefits only when:  You receive emergency medical care.  You receive services to diagnose or treat the 2019 novel coronavirus disease (COVID-19). See Part 5, “COVID-19 Testing and Treatment” for your coverage for these services.  You receive covered services that are not reasonably available from a preferred provider (see “covered provider” in Part 2 of this Subscriber Certificate) and you had prior approval from Blue Cross Blue Shield HMO Blue to obtain these covered services. Or, you receive covered services from a covered provider before a preferred network is established for that type of provider.  You are traveling outside of Massachusetts and you receive covered services from a type of covered provider for which the local Blue Cross and/or Blue Shield Plan has not, in the opinion of Blue Cross Blue Shield HMO Blue, established an adequate PPO health care network.  You receive medically necessary covered services while you are at a preferred hospital or other preferred facility and you do not have a reasonable opportunity to choose to have your covered services furnished by a preferred provider. For example, you receive covered services from a non-preferred hospital-based anesthetist, pathologist, or radiologist while you are at a preferred hospital.  You receive certain covered services that are protected from surprise billing as described in Part 2. (See “Allowed Charge” for more information.)  You are a newly enrolled group member who is having an ongoing course of treatment from a physician (or a primary care provider that is a nurse practitioner or physician assistant) who does not participate in your health care network, and your group only offers its employees a choice of health insurance plans in which your physician (or your primary care provider that is a nurse practitioner or physician assistant) does not participate as a covered provider. In this case, this health plan will provide coverage for covered services you get from that health care provider up to 30 days from your effective date or, for a member who is in the second or third trimester of pregnancy, up through the first post-partum visit or, for a member with a terminal illness, until the member’s death. (For a member with a terminal illness, this coverage is provided only when the member is expected to live six months or less as determined by a physician.) This health plan will also provide in-network benefits in the event Medicare is your primary payor (as allowed by federal law) and you receive covered services from a non-preferred provider outside of Massachusetts and that provider accepts Medicare assignment, whether or not the provider participates with the local Blue Cross and/or Blue Shield Plan. (Medicare assignment is an agreement by the provider to accept the Medicare-approved amount as payment in full for services furnished.) When Your Provider Disenrolls (or is Involuntarily Disenrolled) From the Network If your provider disenrolls from the network for a reason other than a quality-related reason or fraud, this health plan will provide coverage for covered services that you receive from a health care provider who does not participate in your health care network. As required by law, this continuity of care coverage is described below in this section. If you receive covered services from a covered health care provider who does not participate in your health care network, you may receive coverage from this health plan only when: