Explanation of Benefits. Contractor shall send each Enrollee an Explanation of Benefits to Enrollees in Plans that issue Explanation of Benefits or similar documents as required by Federal and State laws, rules, and regulations. The Explanation of Benefits and other documents shall be in a form that is consistent with industry standards.
Explanation of Benefits. Contractor shall send each Enrollee, by mail, an Explanation of Benefits (EOB) to Enrollees in Plans that issue EOBs or similar documents as required by Federal and State laws, rules and regulations. The EOB and other documents shall be in a form that is consistent with industry standards.
Explanation of Benefits. (EOB) – A statement sent from the Contractor to an Enrollee listing services provided, amount billed, eligible expenses and payment made by the Plan.
Explanation of Benefits. (EOB) means the statement AvMed sends to Members to explain what items or services we paid for on behalf of a Member, how much we paid, and the Member’s cost-sharing responsibility pursuant to the terms of the Plan. The EOB is not a bill. It simply explains how the Member’s benefits were applied to that particular Claim.
Explanation of Benefits. Contractor shall send each Covered California Enrollee an Explanation of Benefits to Covered California Enrollees in Plans that issue Explanation of Benefits or similar documents as required by Federal and State laws, rules, and regulations. The Explanation of Benefits and other documents shall be in a form that is consistent with industry standards.
Explanation of Benefits. Once DDPOK has received the claim form, and all necessary information, a copy of an Explanation of Benefits will be sent to the Subscriber by DDPOK within a reasonable time, but no later than thirty (30) days after receipt of a claim. DDPOK may extend this time period one time up to fifteen (15) days, prior to the expiration of the thirty (30) day period. If DDPOK requires additional information necessary to decide the claim, the notice of extension shall specifically describe the required information, and the Subscriber will be given forty−five (45) days from receipt of the notice within which to provide the necessary information.
Explanation of Benefits. (EOB) – A statement sent from the Contractor to an Enrollee listing services provided, amount billed, eligible expenses and payment made by the Plan. Explanation of Payment (EOP) – A statement sent from the Contractor to Providers detailing payments made for Covered Services. Formulary – A list of outpatient prescription drugs, selected by the Plan(s) and revised periodically, which are available to Enrollees in a specific QHP. General Agent - A licensed insurance brokerage firm, qualified and operating under the laws of the state of California, with a network of affiliated Agents in the state of California, that is contracted with Covered California. Grace Period – A specified time following the premium due date during which coverage remains in force and an Enrollee or Employer or other authorized person or entity may pay the premium without penalty.
Explanation of Benefits. A form issued upon adjudication of a claim, as required by law, indicating the dental service(s) performed, the amount of charges paid by the Plan, and the amount of charges the Subscriber is responsible to pay.
Explanation of Benefits. Market Retail Contracts 26 PART 3: Green Option Terms and Conditions 28 PART 4: Privacy Policy 29
Explanation of Benefits. (EOB) – A statement sent from the Contractor to an Enrollee listing services provided, amount billed, eligible expenses and payment made by the Plan. Explanation of Payment (EOP) – A statement sent from the Contractor to Providers detailing payments made for Health Care Services. Family Dental Plan – A plan certified by Covered California that provides the pediatric dental benefits required in Health and Safety Code § 1367.005(a)(5) and Insurance Code § 10122.27(a)(5), and also includes coverage for certain benefits for adult Enrollees. Family Member – An individual who is within an Enrollee’s or Employee’s family, as defined in 26 U.S.C. § 36B (d)(1).
