Co-Payments. Effective January 1, 2020, the State Dental Plan will cover allowable charges for the following services subject to the co- payments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per year and special cleanings (root or deep cleaning) as prescribed by the dentist.
Co-Payments. A. The Contractor may submit service claims to Participants' private insurance carriers and/or to Medicare/Medicaid (if the Contractor is a Medicare/Medicaid provider) for co- payment reimbursement. Upon the insurance/Medicare/Medicaid payment exceeding the allowed co-payment amounts (as defined in Sections G.4.3.B-D), the Participant is no longer eligible for subsidy, pursuant to Section G.4.4. The Contractor is responsible for knowing and understanding the terms and requirements set forth by Medicare/Medicaid with regard to reimbursement.
Co-Payments. The Contractor shall not set co-payment amounts that exceed the Department’s Fee for Service co-payments. The co-payment requirements for the Medicaid Program can be found in 907 KAR 1:604. Any cost sharing imposed by the Contractor shall be in accordance with 42 C.F.R. §§447.50 through 447.82. The Department will calculate payments to the Contractor as set forth in 42 CFR 447.56(d). The actuarial value of the co-payments will be reflected in the Capitation Rate. The Department may exclude the collection of co-payments with at least ninety (90) days written notice to the Contractor.
Co-Payments. Effective January 1, 2012, the State Dental Plan will cover allowable charges for the following services allowable charges for the following services subject to the co-payments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per year and special cleanings (root or deep cleaning) as prescribed by the dentist. SERVICE IN-NETWORK OUT-OF-NETWORK Diagnostic/Preventive 100% 50% after deductible Fillings 60% After Deductible 50% after deductible Endodontics 60% After Deductible 50% after deductible Periodontics 60% After Deductible 50% after deductible Oral Surgery 60% After Deductible 50% after deductible Crowns 60% After Deductible 50% after deductible Prosthetics 50% after deductible 50% after deductible Prosthetic Repairs 50% after deductible 50% after deductible Orthodontics* 50% after deductible 50% after deductible *Please refer to your certificate of coverage for information regarding age Limitations for dependent orthodontic care.
Co-Payments. You understand that the Membership Fee does not affect the co- payments, co-insurance, or deductibles You are required to pay pursuant to the terms of Your insurance coverage. You will continue to be financially responsible for any co- payments,co-insurance, or deductible amounts required by Your insurers.
Co-Payments. (A). An adjustment to each bargaining unit member’s contribution percentage may be made based upon the member’s participation or non-participation in the Personal Health Assessment (PHA) or similar participation in specified preventive care, wellness, care management or related healthcare programs or initiatives. Members will be provided an alternative means to complete the web-based PHA tool, if requested by such member; and
Co-Payments. You remain financially responsible for all co-payments, coinsurance and/or deductibles as defined by the terms of your insurance coverage for provision of covered services.
Co-Payments. Certain covered services and benefits are subject to co-payments by Enrollees and their Dependents, as described in the enclosed Evidence of Coverage.
Co-Payments a. The Health Plan shall not require a co-payment or cost sharing for services listed in Section V.A., Covered Services, Section V.B., Optional Services, if provided, or Section V.C., Expanded Services, nor may the Health Plan charge Enrollees for missed appointments.
Co-Payments. Items or services furnished to an Indian directly by Indian Health Services, an Indian Tribe or Tribal Organization or an Indian Urban Organization (I/T/U), or through referral under contract health services are exempt from copayments, coinsurance, deductibles, or similar charge. All other MinnesotaCare Caretaker Adults and MinnesotaCare Adults without Children may be charged co-payments that exceed the amounts allowed in the Minnesota Medicaid State Plan, as follows:
