; (2) the total claims that were submitted by out-of-network health care providers with respect to enrollees under the plan or coverage, and the number of such claims that were paid and the number of such claims that were denied; (3) with respect to each out-of-network claim, the out-of-pocket costs to the enrollee for the services; (4) the number of out-of-network claims reported under paragraph (2) that are for emergency services