Common use of for exclusions Clause in Contracts

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.

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.