Copayment. A fixed amount You pay directly to a Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Cost-Sharing: Amounts You must pay for Covered Services, expressed as Copayments, Deductibles and/or Coinsurance. Cover, Covered or Covered Services: The Medically Necessary services paid for, arranged, or authorized for You by Us under the terms and conditions of this Contract. Deductible: The amount You owe before We begin to pay for Covered Services. The Deductible applies before any Copayments or Coinsurance are applied. The Deductible may not apply to all Covered Services. You may also have a Deductible that applies to a specific Covered Service that You owe before We begin to pay for a particular Covered Service. Dependents: The Subscriber’s Spouse and Children. Emergency Dental Care: Emergency dental treatment required to alleviate pain and suffering caused by dental disease or trauma. Refer to the Pediatric Dental Care and Adult Dental Care sections of this Contract for details.
Copayment. A specified dollar amount which [Member] must pay for certain Covered Services or Supplies. NOTE: The Emergency Room Copayment, if applicable, must be paid in addition to any other Copayments, Coinsurance [or Cash Deductible]. COSMETIC SURGERY OR PROCEDURE. Any surgery or procedure which involves physical appearance, but which does not correct or materially improve a physiological function and is not Medically Necessary and Appropriate.
Copayment. The defined dollar amount that you must pay when you receive a covered Service as described in the “What You Pay” section.
Copayment. Is the fixed rate of covered expenses that every insured must pay directly to the medical or hospital service provider before receiving services regardless of benefit limits and is indicated in your Table of Benefits.
Copayment. For Preventive Care NONE For all other Primary Care Physician Visits [amount consistent with N.J.A.C. 11:22- 5.5(a)] ] per visit Maternity (pre-natal care) NONE For Prescription Drugs [Copayments consistent with N.J.A.C. 11:22-5.5] For all other services and supplies Copayment Not Applicable; Refer to the Deductible and Coinsurance sections DEDUCTIBLE PER CALENDAR YEAR •For Primary Care Physician Visits including Preventive Care and immunizations and lead screening for children NONE •Maternity (pre-natal care) NONE. •Second Surgical Opinion NONE •for all other Covered Services and Supplies •Per Covered Person Dollar amount not to exceed deductible permitted by 45 CFR 156.130(b)] • [Per Covered Family [Dollar amount which is two times the individual Deductible.] COINSURANCE For Preventive Care 0% Prescription Drugs 50% [Vision Benefits (for Covered Persons through the age of 18) V2500 – V2599 Contact Lenses [50%] Optional lenses and treatments [50%]] [Dental Benefits (for Covered Persons through the age of 18) Preventive, Diagnostic and Restorative services 0% Endodontic, Periodontal, Prosthodontic and Oral and Maxillofacial Surgical Services [20%] Orthodontic Treatment [50%]] For all other services and supplies to which a Copayment does not apply [10% - 50%, in 5% increments] For all services and supplies to which a Copayment applies None EMERGENCY ROOM COPAYMENT [amount consistent with N.J.A.C. 11:22-5.5] Copayment/visit/Member (credited toward Inpatient admission if admission occurs within 24 hours as the result of the emergency).
Copayment. A cost sharing arrangement in which the Member pays a specified amount for specific health services such as office visits, outpatient prescriptions, and emergency room visits directly to the Participating Providers, as specifically provided in the Evidence of Coverage. Copayment fees are normally paid at the point of service when the service is rendered.
Copayment the amount listed in the Schedules and charged to an Enrollee by a Contract Dentist or Contract Specialist for the Benefits provided under the plan. Copayments must be paid at the time treatment is received.
Copayment. The specific dollar amount a Member is required to pay at the time of service for certain Covered Services under the Agreement, as set forth in the Allowances Schedule. Cost Share: The portion of the cost of Covered Services the Member is liable for under the Agreement. Cost Shares for specific Covered Services are set forth in the Allowances Schedule. Cost Share includes Copayments, coinsurances and/or Deductibles. Covered Services: The services for which a Member is entitled to coverage under the Agreement. Deductible: A specific amount a Member is required to pay for certain Covered Services before benefits are payable under the Agreement. The applicable Deductible amounts are set forth in the Allowances Schedule. Dependent: Any member of a Subscriber’s family who meets all applicable eligibility requirements, is enrolled hereunder and for whom the premium prescribed in the Premium Schedule has been paid.
Copayment. A fixed amount, for exam- ple, fifteen dollars ($15), the member pays for a covered health care service, usually when the member receives the service. The amount can vary by the type of covered health care service.
Copayment a specified dollar amount of eligible expenses which the Member is required to pay for a specified Covered Service and which will be deducted from the Plan Allowance before the determination of the benefits payable under this Agreement is made.
