for exclusions Sample Clauses

for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider.
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for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • the network provider has a Standard or Enhanced benefit designation; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider.
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for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Network and Non-Network Provider Services The following network assignments shall apply to this plan: Network Assignments Important Information Network Provider Services Network providers are those healthcare providers that have entered into a contract to provide covered healthcare services for this plan. If you receive covered healthcare services from a network provider, the provider has agreed to accept our payment for covered healthcare services as payment in full, excluding your copayments, deductible (if any), and the difference between the benefit limit and our allowance. This plan uses the BlueCHiP provider network. Our service area for network providers includes Rhode Island and the counties of Connecticut and Massachusetts that border Rhode Island. Non-network Provider Services Non-network providers are those healthcare providers that have not entered into a contract to provide covered healthcare services for this plan. Services received from a non-network provider are not covered except in the following special circumstances: • emergency care (emergency room, urgent care and ground ambulance services); • air ambulance services; • we specifically approve the use of a non-network provider for covered healthcare services, see Network Authorization in Section 5 for details; Network Assignments Important Information • certain non-emergency covered healthcare services performed by a non-network provider at a network facility as described in Section 5; • otherwise, as required by law. In these special circumstances, the services rendered by a non- network provider will be covered at the network benefit level shown in the Summary of Medical Benefits. The deductible and maximum out-of-pocket expenses are calculated based on the lower of our allowance or the provider’s charge, unl...
Sample 1Sample 2Sample 3
for exclusions. The amount you pay for covered healthcare services can differ based on the following:  the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy;  the healthcare provider is from a Tier 1 or Tier 2 in-network provider, an out-of-network provider, or a non-participating provider;  the deductible (if any), copayment, or benefit limits applied;  you reached your plan year maximum out-of-pocket expense;  there are exclusions from coverage that apply; or  our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by an in-network provider. All of our payments at the benefit levels noted below are based upon a fee schedule called our allowance.
Sample 1
for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a p h y s i cofificae, nin ’yosur home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • the deductible (if any), copayment, or benefit limits applied; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. All of our payments at the benefit levels noted below are based upon a fee schedule called our allowance.
Sample 1

Related to for exclusions

  • Requests for Exclusion Any Settlement Class member who wishes to opt-out of the Settlement must complete and mail a Request for Exclusion (defined below) to the Settlement Administrator within sixty (60) calendar days of the date of the initial mailing of the Notice Packets (the “Response Deadline").

  • Requests for Exclusion (Opt-Outs) 8.5.1 Class Members who wish to exclude themselves (opt-out of) the Class Settlement must send the Administrator, by fax, email, or mail, a signed written Request for Exclusion not later than 60 days after the Administrator mails the Class Notice (plus an additional 14 days for Class Members whose Class Notice is re-mailed). A Request for Exclusion is a letter from a Class Member or his/her representative that reasonably communicates the Class Member’s election to be excluded from the Settlement and includes the Class Member’s name, address and email address or telephone number. To be valid, a Request for Exclusion must be timely faxed, emailed, or postmarked by the Response Deadline.

  • For example If an employee utilises two weeks recreation leave over a period of four weeks at half pay, service based entitlements (e.g. personal leave, long service leave, paid parental leave) will be deferred by two weeks.

  • GENERAL EXCLUSIONS A. We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects a substantial area.

  • Service Exclusions All of an Employee's years of Service with the Employer shall be counted to determine the vested interest of such Employee except:

  • TENURE EXCLUSION This contract does not confer tenure upon the Superintendent in the position of Superintendent or any other administrative position in the district.

  • General Exclusion Neither we nor our directors, officers, employees, or agents shall be liable for any losses, damages, costs or expenses, whether arising out of negligence, breach of contract, misrepresentation or otherwise, incurred or suffered by you under this Agreement (including any Transaction or where we have declined to enter into a proposed Transaction) unless such loss is a reasonably foreseeable consequence or arises directly from our or their respective gross negligence, wilful default or fraud. In no circumstance, shall we have liability for losses suffered by you or any third party for any special or consequential damage, loss of profits, loss of goodwill or loss of business opportunity arising under or in connection with this Agreement, whether arising out of negligence, breach of contract, misrepresentation or otherwise. Nothing in this Agreement will limit our liability for death or personal injury resulting from our negligence.

  • Specific Exclusions Apart from the exclusions common to all covers, the following are also excluded. We do not intervene for:  Travel taken for the purpose of diagnosis and/or treatment,  Medical and hospitalisation expenses in the country of residence,  Drunkenness, suicide or attempted suicide and their consequences,  Any voluntary mutilation of the insured,  Ailments or benign injuries which can be treated on site and/or which do not prevent the Beneficiary/Insured from continuing his trip,  The states of pregnancy, unless there are unforeseeable complications, and in all cases, the states of pregnancy beyond the 36th week, voluntary termination, the aftermath of childbirth,  Convalescence and ailments during treatment, not yet consolidated and involving a risk of sudden aggravation,  Illnesses diagnosed previously that have resulted in hospitalisation in the 6 months preceding the date of departure on the trip,  Events related to medical treatment or surgery that are not unforeseen, fortuitous or accidental,  Prosthesis costs: optical, dental, acoustic, functional, etc.  The consequences of infectious risk situations in an epidemic context that are subject to quarantine or preventive measures or specific surveillance by the international health authorities and/or local health authorities of the country where you are staying and/or national authorities of your country of origin, unless otherwise specified in the cover.  The costs of spa treatment, cosmetic treatment, vaccination and resultant costs,  Stays in a rest home and the resultant costs,  Rehabilitation, physiotherapy, chiropractic and resultant costs,  Scheduled hospitalisations. In the event of significant trauma following your quarantine related to a context of epidemic or pandemic, we can, at your request, put you in contact with a psychologist by telephone, within the limit indicated in the Schedule of Cover. These sessions are strictly confidential. This listening work is not to be confused with the psychotherapeutic work done by licensed practitioners. Under no circumstances can this service be a substitute for psychotherapy, due to the physical absence of the caller. EMERGENCY SUITCASE In the event that you no longer have enough usable personal effects at your disposal due to your quarantine or your hospitalisation following an epidemic or pandemic, we pay, on presentation of supporting documents, for basic necessities, up to the amount indicated in the Schedule of Cover. DOMESTIC HELP Following your repatriation by us following an illness linked to an epidemic or a pandemic, if you cannot perform your usual household chores, we look for, arrange and pay for domestic help assistance, within the limit indicated in the Schedule of Cover. DELIVERY OF HOUSEHOLD SHOPPING Following your repatriation by us following an illness linked to an epidemic or a pandemic, if you are not able to leave your home, we organize and cover, within the limit of local availability, the costs of delivery of your shopping within the limit set in the Schedule of Cover. PSYCHOLOGICAL SUPPORT UPON YOUR RETURN HOME In the event of significant trauma following an event related to a context of epidemic or pandemic, we can, at your request, put you in contact with a psychologist by telephone after you return home, within the limit indicated in the Schedule of Cover. These sessions are strictly confidential. This listening work is not to be confused with the psychotherapeutic work done by licensed practitioners. Under no circumstances can this service be a substitute for psychotherapy, due to the physical absence of the caller. NEED ASSISTANCE? Contact us, 7 days/week and 24 hours/day By ‘phone from France: By e-mail +00 0 00 00 00 00 (Call not surcharged, cost according to operator, call may be recorded) xxxxxxxxxx@xxxxxxxx.xx To allow us to intervene under the best conditions, remember to prepare the following information that will be requested when you call: › Your policy number, › Your last and first names, › Your home address, › The country, city or town where you are at the time of the call, › Specify the exact address (no., street, hotel possibly, etc.), › The phone number where we can reach you, › The nature of your problem. When you call initially, you will be given an assistance file number. State it systematically during any subsequent contacts with our Assistance Service.  General Provisions - the policy came with the purchase of goods or a service sold by a supplier; - you can show that you are already covered for one of the risks covered by this new policy; - the policy you wish to cancel has not been fully established; - you have not declared any loss covered by this policy. In this situation, you can exercise your right to cancel this policy by letter or in any lasting medium sent to the insurer of the new policy, together with documentary proof that you already have cover for one of the risks covered by this new policy. The insurer must reimburse you the premium paid within thirty days of your cancellation. If you wish to cancel your policy but do not meet all the above conditions, please check the cancellation procedure stipulated in your policy. Like any insurance policy, this one comprises mutual rights and obligations. It is governed by the French Insurance Code. These rights and obligations are set forth in the following pages. This is a collective damage insurance policy taken out by Gritchen Affinity with MUTUAIDE ASSISTANCE with optional membership.

  • Additional Exclusions The Insurer shall not be liable for:

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