Allowable Amount definition

Allowable Amount is defined in the EOC. In addition: • Coinsurance is calculated from the Allowable Amount or Benefit maximum, whichever is less.

Allowable Amount means the maximum amount determined by HMO to be eligible for consideration of payment for a particular Covered Drug. As applied to Participating Pharmacies the Allowable Amount is based on the provisions of the contract between HMO and the Participating Pharmacy in effect on the date of service. As applied to Prescription Drugs Purchased Outside of the Service Area, the Allowable Amount is based on the Participating Pharmacy contract rate.

Allowable Amount on any date, means:

Examples of Allowable Amount in a sentence

• The usual and customary rate shall not be less that the non-contracting Allowable Amount as defined in this Policy.

• The Allowable Amount will be the lesser of (1) the actual charge, or (2) the Average Wholesale Price (AWP) plus a predetermined percentage mark-up or mark down from the AWP wholesale price established by BCBSTX and updated on a periodic basis.

• If the Allowable Amount of the Covered Drug is less than the Copayment Amount, the Participant will pay the lower cost.

• Other Providers Contracting with BCBSTX in Texas or any other Blue Cross and Blue Shield plan – The Allowable Amount is based on the terms of the Provider contract and the payment methodology in effect on the date of service.

• If your Policy has Out of Network benefits The Medical Benefits; Benefits for Emergency Care provision of your Policy or Amendment, if applicable, is amended by adding the following: For Out-of-Network Emergency Care services rendered by non-contracting Providers, the Allowable Amount shall be BCBSTX’s usual and customary rate or at a rate agreed to between BCBSTX and the noncontracting Provider, not to exceed billed charges.

More Definitions of Allowable Amount

Allowable Amount means the maximum amount determined by Us to be eligible for consideration of payment for a particular service, supply or procedure.

Allowable Amount the lesser of (i) the Borrowing Base less Availability Reserves and (ii) the Maximum Amount.

Allowable Amount on any date, means with respect to Eligible Securities, the aggregate principal amount of such Eligible Securities theretofore advanced thereon which remains unpaid on such date.

Allowable Amount means the maximum amount determined by HMO to be eligible for consideration of payment for a particular service, supply or procedure rendered by a Participating Provider. The Allowable Amount is based on the provisions of the Participating Provider contract and the payment methodology in effect on the date of service, whether diagnostic related grouping (DRG), capitation, relative value, fee schedule, per diem or other.

Allowable Amount means, with respect to any Acceptable Obligor, such amount as may be specified on Schedule 1.2 hereto (as applicable) as the maximum aggregate exposure for such Acceptable Obligor (as modified from time to time in accordance with Section 2.20 hereof).

Allowable Amount means the lesser of the Borrowing Base and the Maximum Amount.

Allowable Amount means the maximum amount determined by HMO to be eligible for consideration of payment for a particular service, supply or procedure rendered by a Participating Provider. The Allowable Amount is based on the provisions of the Participating Provider contract and the payment methodology in effect on the date of service, whether diagnostic related grouping (DRG), capitation, relative value, fee schedule, per diem or other. Approved Clinical Trial means a phase I, phase II, phase III, or phase IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or other Life-Threatening Disease or Condition. The trial must be: