Secondary Plan Sample Clauses

Secondary Plan. The Plan that typically determines its benefits after those of another Plan and may reduce the benefits it pays so that all Plan benefits do not exceed 100% of the total Allowable Expense deemed customary and reasonable by Keystone. Covered Service: A service or supply specified in This Coverage for which benefits will be provided when rendered by a Provider to the extent that such item is not covered completely under the Other Plan. When benefits are provided in the form of services, the reasonable cash value of each service shall be deemed the benefit. Keystone will not be required to determine the existence of any Other Plan, or amount of benefits payable under any Other Plan, except This Coverage. The payment of benefits under This Coverage shall be affected by the benefits that would be payable under Other Plans only to the extent that Keystone is furnished with information regarding Other Plans by the Member or Subscriber or any other organization or person. Allowable Expense: Allowable expense is a health care expense, including Deductibles, Coinsurance, and Copayments, that is covered at least in part by any Plan covering the Member. When a Plan provides benefits in the form of services, the reasonable cash value of each service will be considered an Allowable Expense and a benefit paid. An expense that is not covered by any Plan covering the Member is not an Allowable Expense. In addition, any expense that a Provider by law or in accordance with a contractual agreement is prohibited from charging a Member is not an Allowable Expense. Examples of expenses that are not Allowable Expenses include, but are not limited to:  The difference between the cost of a semi-private Hospital room and a private Hospital room, unless one of the Plans provides coverage for private Hospital room expenses.  Any amount in excess of the highest reimbursement amount for a specific benefit when two (2) or more Plans that calculate benefit payments on the basis of usual and customary fees or relative value schedule reimbursement methodology or other similar reimbursement methodology cover the Member.  Any amount in excess of the highest of the negotiated fees when two (2) or more Plans that provide benefits or services on the basis of negotiated fees cover the Member.  If the Member is covered by one Plan that calculates its benefits or services on the basis of usual and customary fees or relative value schedule reimbursement methodology or other similar reimbursement...
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Secondary Plan. In addition to the above-described Health Insurance Contribution Payment, employees who elect secondary coverage or any other plan voluntarily offered by the City shall pay the excess cost, if any, of the secondary or other such coverage over the primary coverage, provided however, those employees who are subscribing to Blue Cross Classic as of July 1, 2000, shall be able to continue to receive Classic Blue as their Primary Health Care Coverage with no additional cost or co-pay to them. All other employees, including new employees hired on, or after, July 1, 2000, shall not be eligible to receive Classic Blue as their Primary Health Care coverage, but shall only be able to select Classic Blue as their Secondary Health Care coverage. Furthermore, employees who currently are able to keep Classic Blue as their Primary Health Care coverage, but who in the future decide to change to Healthmate Coast to Coast, shall not be eligible to change back to Classic Blue as Primary Health Care coverage but shall only be able to select Classic Blue as their Secondary Health Care coverage. Notwithstanding the above, any employee who retires shall be eligible to select Blue Cross Classic Blue at the time of his/her retirement for his/her “retiree health care coverage” with no additional cost or co-pay to him/her, to the extent Classic Blue is available from Blue Cross at the time.
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Secondary Plan. The Plan that pays after the Primary Plan is the Secondary Plan. The Secondary Plan may reduce the benefits it pays so that payments from all Plans do not exceed 100% of the total Allowable Expense. Allowable Expense is defined below.
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Secondary Plan. The plan that determines its benefits after those of the other plan (primary plan). Benefits may be reduced because of the other plan’s (primary plan) benefits. Plan – This document including all schedules and all riders thereto, providing dental care benefits to which this COB provision applies, and which may be reduced as a result of the benefits of other dental plans. COB Determination Rules The fair value of services provided by Blue Cross will be considered to be the amount of benefits paid by us. We will be fully discharged from liability to the extent of such payment under this provision.
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Secondary Plan. The Plan that will determine its benefits after those of another Plan and may reduce the benefits so that all Plan benefits do not exceed 100% of the total Allowable Expense.
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Secondary Plan. (Secondary) means a plan that is not a primary plan.
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Secondary Plan. A Plan that determines and may reduce its benefits after taking into consideration the benefits provided or paid by the Primary Plan. A Secondary Plan may also recover the Reasonable Cash Value of any services it provided to you from the Primary Plan. Allowable Expense The amount of charges considered for payment under the plan for a Covered Service prior to any reductions due to coinsurance, copayment or deductible amounts. If the Healthplan contracts with an entity to arrange for the provision of SAMPLE DOCUMENT Covered Services through that entity's contracted network of health care providers, the amount that the Healthplan has agreed to pay that entity is the allowable amount used to determine your coinsurance or deductible payments. If the Plan provides benefits in the form of services, the Reasonable Cash Value of each service is the Allowable Expense and is a paid benefit. Examples of expenses or services that are not an Allowable Expense include, but are not limited to the following:
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Secondary Plan. A Plan that determines, and may reduce its benefits after taking into consideration, the benefits provided or paid by the Primary Plan. A Secondary Plan may also recover the Reasonable Cash Value of any services it provided to you. Allowable Expense A necessary, reasonable and customary service or expense, including deductibles, coinsurance or copayments that are covered in full or in part by any Plan covering you. When a Plan provides benefits in the form of services, the Reasonable Cash Value of each service is the Allowable Expense and is a paid benefit. SAMPLE DOCUMENT Examples of expenses or services that are not Allowable Expenses include, but are not limited to the following:
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Related to Secondary Plan

  • Marketing Plan The MCP shall submit an annual marketing plan to ODM that includes all planned activities for promoting membership in or increasing awareness of the MCP. The marketing plan submission shall include an attestation by the MCP that the plan is accurate is not intended to mislead, confuse or defraud the eligible individuals or ODM.

  • Drug Plan 42.01 The parties agree to the continuation of the Drug Care plan as follows:

  • Staffing Plan 8.l The Board and the Association agree that optimum class size is an important aspect of the effective educational program. The Polk County School Staffing Plan shall be constructed each year according to the procedures set forth in Board Policy and, upon adoption, shall become Board Policy.

  • Prescription Drug Plan Effective July 1, 2011, retail and mail order prescription drug copays for bargaining unit employees shall be as follows: Type of Drug Prescriptions for 1-45 Days (1 copay) Prescriptions for 46-90 Days (2 copays) Generic drug $10 $20 Preferred brand name drug $25 $50 Non-preferred brand name drug $40 $80 Effective July 1, 2011, for each plan year the Prescription Drug annual out-of- pocket copay maximum shall be $1,000 for individual coverage and $1,500 for employee and spouse, employee and child, or employee and family coverage.

  • Annual Plan On or before November 1 of each calendar year during the Term, Manager shall prepare and submit to Owner for its approval a proposed annual plan for the promotion, operation, leasing, repair and maintenance of the Project for each calendar year (the "Proposed Annual Plan"). For purposes of this Agreement, a "Fiscal Year" shall mean a calendar year beginning on the first day of January and ending on the last day of December. The Annual Plan for the remaining portion of Fiscal Year 2003 is attached hereto as Exhibit "A".

  • Procurement Plan 8. The Borrower shall update the Procurement Plan as needed throughout implementation of the Project, and on each anniversary of the Effective Date, the Borrower shall in consultation with ADB determine whether the Procurement Plan needs to be updated. The Borrower shall implement the Procurement Plan in the manner in which it has been approved by ADB.

  • Quality Assurance Plan The contractor shall develop and submit to NMFS a contractor Quality Assurance Plan, as referenced in Section F.5.3, which details how the contractor will ensure effectiveness and efficiency of collection efforts as well as the quality of data collected by its At-Sea Monitors. The contractor shall further establish, implement, and maintain a Quality Assurance Management program to ensure consistent quality of all work products and services performed under this contract.

  • Pay Plan The minimum rate and maximum rate of pay for each classification in each bargaining unit will be established per the pay range assignments found in Appendix A.

  • Training Plan Within 90 days after the Effective Date, Good Shepherd shall develop a written plan (Training Plan) that outlines the steps Good Shepherd will take to ensure that: (a) all Covered Persons receive adequate training regarding Good Shepherd’s CIA requirements and Compliance Program, including the Code of Conduct and (b) all Relevant Covered Persons receive adequate training regarding: (i) the Federal health care program requirements regarding eligibility for hospice services upon initial admission, recertification for continued stay, and for Continuous Care, Respite Care, and General Inpatient Care; (ii) the role of physicians in making eligibility determinations; (iii) the accurate coding and submission of claims; (iv) policies, procedures, and other requirements applicable to the documentation of medical records; (v) the personal obligation of each individual involved in the claims submission process to ensure that such claims are accurate; (vi) applicable reimbursement statutes, regulations, and program requirements and directives; (vii) the legal sanctions for violations of the Federal health care program requirements; and (viii) examples of proper and improper eligibility determinations, documentation, and claims submission practices. The Training Plan shall include information regarding the training topics, the categories of Covered Persons and Relevant Covered Persons required to attend each training session, the length of the training, the schedule for training, and the format of the training. Within 30 days of the OIG’s receipt of Good Shepherd’s Training Plan, OIG will notify Good Shepherd of any comments or objections to the Training Plan. Absent notification by the OIG that the Training Plan is unacceptable, Good Shepherd may implement its Training Plan. Good Shepherd shall furnish training to its Covered Persons and Relevant Covered Persons pursuant to the Training Plan during each Reporting Period.

  • Management Plan The Management Plan is the description and definition of the phasing, sequencing and timing of the major Individual Project activities for design, construction procurement, construction and occupancy as described in the IPPA.

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