Reasonable and Customary Costs definition

Reasonable and Customary Costs means costs that are incurred for approved, covered medical services or supplies that do not exceed the standard fee of other providers of similar standing in the same geographical area, for the same treatment of a similar sickness and/or injury.
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Reasonable and Customary Costs means costs that are incurred for approved, eligible medical services or supplies that do not exceed the average reimbursement the provider receives for all services rendered to its patients, up to a maximum of one and a half times the rate that would be applicable if the costs were payable by US Medicare.
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Reasonable and Customary Costs has the meaning set forth in Section 4.5(f).
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Examples of Reasonable and Customary Costs in a sentence

  • If you incur any expenses without prior approval by Global Excel, such expenses will be covered, except where the Policy expressly requires the prior approval or authorization of Global Excel, on the basis of the Reasonable and Customary Costs that would have been payable for such expenses by the Insurer in accordance with the terms and conditions of the Policy.

  • Reasonable and Customary Costs mean costs that are incurred for approved, eligible medical services or supplies and that do not exceed the standard fee of other providers of similar standing in the same geographical area, for the same treatment of a similar sickness or injury.Sickness means a disease or disorder of the body which results in loss while this coverage is in effect.

  • Reasonable and Customary Costs — If you pay eligible expenses directly to a health service provider, these services will be reimbursed to you on the basis of the reasonable and customary costs that would have been paid directly to the provider by the Insurer.

  • If You incur any expenses without prior approval by Global Excel, such expenses will be covered, except where the Policy expressly requires the prior approval or authorization of Global Excel, on the basis of the Reasonable and Customary Costs that would have been payable for such expenses by the Insurer in accordance with the terms and conditions of the Policy.

  • In the event of an elected caesarean section, this policy excludes expenses relating to the caesarean section procedure, but will reimburse the Reasonable and Customary Costs for Hospital room and board charges (up to semi-private room accommodation), subject to the Maternity Benefit maximum.

  • SPECIFIC CONDITIONS APPLYING TO SECTION 1.1 In the case of what Our Medical Advisor considers to be an unreasonable length of stay or unreasonable Hospital charges, We reserve the right to limit payment to what Our Medical Advisor considers to be Usual, Reasonable and Customary Costs.

  • Reasonable and Customary Costs: Costs incurred for approved, eligible treatment or supplies that do not exceed the standard costs of other providers of similar standing in the same region, for the same treatment of a similar Sickness or Injury.

  • Medical, Surgical and Diagnostic ServicesWhen by reason of Injury or Sickness, an Insured Person incurs expenses for any of the following while under the regular care and attendance of a Physician or Surgeon, the Insurer will pay the Reasonable and Customary Costs incurred for the following:» Diagnostic, X-Ray, and Laboratory Services.

  • The Insurer will reimburse the Reasonable and Customary Costs incurred for the prepara- tion and transportation of the remains of the deceased Insured Person to his/her residence in Canada or the Reasonable and Customary Costs of cremation or burial at the place of death.

  • We will reimburse the Reasonable and Customary Costs for an Immediate Family Member’s round-trip economy class flight, up to a maximum of $5,000 when either:• you are hospitalized as an in-patient for seven consecutive days or more and the attending Physician has requested that an Immediate Family Member be in attendance; or• it is necessary for an Immediate Family Member to identify your body before the release of your body.


More Definitions of Reasonable and Customary Costs

Reasonable and Customary Costs means costs that are incurred for approved, covered medical services or supplies that do not exceed the standard fee of other providers of similar standin in the same eo raphical area, for the same treatment of a similar
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Reasonable and Customary Costs means the amount usually charged for treatment, services or supplies to provide an appropriate level of care given the severity of the Sickness or Injury being treated, in the geographical location where the treatment, services or supplies are being provided.
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Reasonable and Customary Costs means costs that are incurred forapproved, coveredmedical services orsuppliesthat do not exceed the standard fee of other providers of similar standing in the same geographical area, for the same treatment of a similar sickness and/or injury.
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Reasonable and Customary Costs means costs that are incurred forapproved, coveredmedicalservices or suppliesthat donot exceed the standard fee of other providers of similar standing in the same geographical area, for the same treatment of a similar sickness and/or injury.
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Related to Reasonable and Customary Costs

  • Reasonable and Customary Charges means expenses which:

  • Usual and Customary Charges means those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.

  • Reasonable Costs means the reasonable actual costs and expenses incurred by us in carrying out any further Audit under this Contract, including, but not limited to, reasonable travel and subsistence costs;

  • Reasonable Additional Expenses means expenses for meals, taxi fares, essential telephone calls, local transportation, and lodging which are necessarily incurred as the result of Trip Delay and which are not provided by the Common Carrier or any other party free of charge.

  • Usual and customary charge means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

  • Usual and Customary (U&C) shall mean covered expenses which are identified by the Plan Administrator, taking into consideration the fee(s) which the Provider most frequently charges the majority of patients for the service or supply, the cost to the Provider for providing the services, the prevailing range of fees charged in the same “area” by Providers of similar training and experience for the service or supply, and the Medicare reimbursement rates. The term(s) “same geographic locale” and/or “area” shall be defined as a metropolitan area, county, or such greater area as is necessary to obtain a representative cross-section of Providers, persons or organizations rendering such treatment, services, or supplies for which a specific charge is made. To be Usual and Customary, fee(s) must be in compliance with generally accepted billing practices for unbundling or multiple procedures.

  • Reasonable cost means a cost for a service or item that is consistent with the market standards for comparable services or items.

  • Reimbursable Costs means expenses incurred by the employee in the course of engaging in the planned learning activity and include registration, tuition and examination fees as well as textbooks/discs and applicable taxes. They may also include reasonable, incremental meal, accommodation and travel expenses.

  • Reasonable compensation means, with respect to a regularly employed officer or employee of any person, compensation that is consistent with the normal compensation for such officer or employee for work that is not furnished to, not funded by, or not furnished in cooperation with the Federal Government.

  • Reasonable in these circumstances means ‘using no more force than is needed’. The use of force may involve either passive physical contact, such as standing between pupils or blocking a pupil’s path, or active physical contact such as leading a pupil by the arm out of the classroom. Departmental advice for schools is available here

  • Mandatory Costs means the percentage rate per annum calculated in accordance with Schedule 1.01(b).

  • Reasonable and Prudent Operator means a person seeking in good faith to perform its contractual obligations and, in the process of doing so and in the overall conduct of its whole undertaking exercising that degree of diligence, skill, prudence and foresight which can reasonably and ordinarily be expected from a skilled and experienced operator engaged in the same type of undertaking under the same or similar circumstances complying with all applicable Laws, and any reference to the standard of a Reasonable and Prudent Operator means such degree of diligence, skill, prudence and foresight as aforesaid.

  • Carrying Costs With respect to any Payment Date, the sum of amounts payable under Section 2.6(a)(v)(A)-(C).

  • Reasonable Distance means a distance that has regard to the Employee’s original work location, current home address, capacity of the Employee to travel, additional travelling time, effects on the personal circumstances of the affected Employee, including family commitments and responsibilities and other matters raised by the Employee, or assistance provided by their Employer.

  • Reasonable access for the purposes of this section means:

  • Program Costs means all necessary and incidental costs of providing program services.

  • Training costs means reasonable costs incurred to upgrade the technological skills of Full-Time Employees in Illinois and includes: curriculum development; training materials (including scrap product cost); trainee domestic travel expenses; instructor costs (including wages, fringe benefits, tuition and domestic travel expenses); rent, purchase or lease of training equipment; and other usual and customary training cots. “Training costs” do not include, except where the Company receives prior written approval of the Department, costs associated with travel outside the United States, wages and fringe benefits of employees during periods of training, administrative costs related to Full-Time Employees of the Taxpayer, or amounts paid to an affiliate of the Company.