Common use of Eligible Charges Clause in Contracts

Eligible Charges. “Eligible Charges” apply when the cost of the item is Covered at least in part by one (1) or more of the plans that cover the Member. Notwithstanding the foregoing, in a coordination of benefits situation where WHP is the secondary plan, Eligible Charges will not include charges or expenses for health care services which are not Covered Services under this Agreement. 12.4.1 WHP will not cover any charges in excess of what an HMO or network Provider has agreed to accept as payment in full. Also, when an HMO or network plan is primary and the Covered Person does not use an HMO or network Provider, WHP will not consider as an allowable charge any charge that would have been Covered by the HMO or network plan had the Covered Person used the services of an HMO or network provider.