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The State Health Plan has networks of physicians and hospitals, ambulatory surgical centers and mammography testing centers. The Plan also makes networks available to subscribers for durable medical equipment, labs, radiology and X-ray, physical therapy, occupational therapy, speech therapy, skilled nursing facilities, long-term acute care facilities, hospices and dialysis centers.

Network providers agree to accept the State Health Plan’s negotiated rate, or allowed amount, as their total fee. It is better to stay in network if possible. An out-of-network provider may bill you the difference in its cost and the allowed amount. Plus, out of network, you will pay 40 percent coinsurance, and your coinsurance maximum is different. This is known as a balance bill. A balance bill does not count toward your annual deductible or coinsurance maximum and will increase your out-of-pocket expenses. Out-of-network payments go directly to the participant and not the provider.

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