Eligible Charge Sample Clauses
An Eligible Charge clause defines which types of charges or costs are considered valid and recoverable under an agreement. Typically, it outlines specific criteria or categories of expenses—such as taxes, regulatory fees, or service-related costs—that a party may claim or pass on to the other party. By clearly specifying what constitutes an eligible charge, this clause helps prevent disputes over unexpected or unauthorized costs, ensuring transparency and predictability in financial obligations.
Eligible Charge. The Eligible Charge for a Covered Service is the lower of either the actual charge as shown on the claim or the charge listed for the service in the HMSA QUEST Fee Schedule (“Schedule”) in effect at the time of service. For a Covered Service that does not have a charge listed in the Schedule, HMSA will establish the Schedule charge. HMSA reserves the right to adjust the charges listed in the Schedule upon sixty (60) calendar days' written notice to Participating Allied Health Provider.
Eligible Charge. The amount of money WHP allows for Covered services. This amount includes what both WHP and the Member are to pay.
Eligible Charge. For a medical service or supply that qualifies for payment under Title XVIII of the Social Security Act (“Title XVIII”) and the regulations and subregulatory guidance promulgated thereunder by CMS (the “Medicare Rules”), the Eligible Charge for a Covered Service is the lower of
(a) the actual charge as shown on the Claim or (b) the amount that otherwise would have been paid directly to the Provider under Title XVIII and Medicare Rules for the service or supply (the “Medicare Payment Amount”). Where a Medicare Payment Amount has not been established, the Eligible Charge shall be the lower of (a) the actual charge as shown on the Claim or (b) the charge listed in HMSA's Schedule of Maximum Allowable Charges (the “Schedule”). HMSA reserves the right to adjust the charges listed in the Schedule upon sixty (60) days’ written notice to Provider. Factors considered by HMSA in making these adjustments may include, but are not limited to, changes in the Honolulu Consumer Price Indices (All Items and Medical Care); cost of providing medical care; relative complexity of the service; payments for the service under federal, state, and other private insurance programs; and the competitive environment. For a Covered Service that does not have a charge listed in the Schedule, HMSA will establish the Maximum Allowable Charge.
Eligible Charge. The Eligible Charge for a Covered Service is the lower of either the actual charge as shown on the claim or the charge listed for the service in HMSA’s Vision Services Fee Schedule for Participating Providers (“Vision Fee Schedule”). HMSA reserves the right to adjust the charges listed in the Vision Fee Schedule Schedule upon sixty (60) calendar days’ written notice to Provider. The Eligible Charge does not include general excise tax or any other tax.