The Out-of-Area Feature is an indemnity, or fee-for-service, benefit. This is a traditional style health benefit that gives you freedom of choice. There is only one level of benefits and no requirement to select a PCP. When you need care, you simply choose any licensed doctor or other health care provider and make an appointment.
Under the Out-of-Area Feature, you pay health care providers directly for their services. Then you file a claim with Aetna for reimbursement. Once you have met your plan's calendar year deductible, the plan generally pays a percentage of the reasonable and customary charges for most covered services, and you pay the rest. "Reasonable and customary" (R&C) is the maximum amount that will be considered an allowable expense. If a charge exceeds the reasonable and customary limit, you pay the difference in addition to your share of coinsurance.
The Out-of-Area Feature protects you against the high cost of a major illness by the annual coinsurance or "out-of-pocket" limit. Once your total coinsurance payments for the year reach this limit, the plan pays 100% for covered services for the rest of the calendar year.
The CSC Out-of-Area Feature is only available to employees in locations not served by the CSC Preferred or Core Access network (In-Area Feature).