Percentage Payable Clause Samples

Percentage Payable. This is the part of Covered Charges that the Administrator pays after the Calendar Year Deductible is satisfied.

Percentage Payable. All necessary dental treatment which has as its objective the correction of malocclusion of the teeth. No payment will be made for expenses resulting from: Self-inflicted injuries or illness while sane or insane. Injury resulting directly or indirectly from insurrection, war, service in the armed forces of any country or participation in a riot. Any injury or illness for which the person is entitled to benefits under any workers’ compensation act. Examinations required for the use of a third party. Travel for health reasons. ▇▇▇▇▇▇▇ levied by a physician or dentist for time spent travelling, broken appointments, transportation costs, room rental charges or for advice given by telephone or other means of telecommunication. Cosmetic surgery or treatment (when so classified by Financial) unless such surgery or treatment is for accidental injuries and commenced within days of an accident.

Percentage Payable. Crowns, including gold and porcelain, when the major portion of the clinical crown is decayed, heavily filled or the cusps are fractured and cannot be restored using basic restorative materials. When crowns are rendered on molar teeth, only the cost of metal material will be considered. when the major portion of the clinical crown is decayed, heavily filled or the cusps are fractured and cannot be restored using Basic Services. Inlays when 3 or more surfaces are involved and the tooth cannot be restored using basic restorative materials. If only 1 or 2 tooth surfaces are involved, the inlay will be considered for reimbursement under Basic Services and payment will be determined based on the cost of a comparable amalgam or composite restoration. Relining, or the repair of an existing denture or existing bridge. The creation of an initial bridge or initial denture. The replacement of an existing bridge or denture, under one of the following circumstances:

Percentage Payable. Hospital (Within Home Province) and Drugs Psychoanalyst (for Quebec residents only) Maximum Stay (per period of disability) lesser of per day or semi-private Maximum subject to the Overall Lifetime Benefit Maximum HEALTH CARE BENEFITS Health Practitioners’ Limits (per calendar year) Chiropractor, Podiatrist, Speech T Physiotherapist or Psychologist Out-of-Province Benefit Maximum (per lifetime) Hospital Room and Board Limit Out of Canada ear per visit, up to a To be eligible for coverage you must an active, permanent employee of an Employer covered under this plan, working full-time and not working on a seasonal basis; in a class shown in the Schedule; and covered under a Provincial Health Insurance Plan. You will become eligible for coverage on the later of: the Effective Date of this plan; or with respect to the Life and Long Term Disability Benefits, upon commencement of employment; with respect to all other benefits, on the first of the month following the completion of month of continuous service.

Percentage Payable. Drug Benefit Early Retirees Drug Benefit Active Employees Other Covered Charges Room and Board Limit semi-private Room and Board Limit per day Maximum Stay (per period of disability) Out-of-Hospital Nursing Benefit Maximum (per lifetime) days Health Practitioners' Limits (per calendar year) Chiropractor, Osteopath, Naturopath, Podiatrist, Chiropodist or Christian Science Practitioner Psychologist (for diagnosis and assessment Physiotherapy per visit, per disability for x-rays, up to a calendar year limit of for all charges combined Reasonable and Customary Charges Vision Care Benefit Maximums (in any 24-month period) Prescription Lenses and Frames or Contact Lenses or Laser Eye Surgery per employee and dependent Hospital Maximum Stay Hospital Room and Board Limit In Canada Out of Canada Drug Benefit: Maximum Period * coverage ceases: days semi-private average semi-private if the employee becomes employed or if the employee becomes deceased; whichever occurs first.