Examples of Allowable Amount in a sentence
When you receive Covered Services from a Non-Participating Provider, you are responsible for:• the Copayment or Coinsurance (once any Calendar Year Deductible has been met), and• any charges above the Allowable Amount.
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.
Once you reach your Out-of-Pocket Maximum, the Claims Administrator will pay 100% of the Allowable Amount for Covered Services for the rest of the Calendar Year.Your payment after you reach the Calendar Year OOPM.
As applied to Prescription Drugs Purchased Outside of the Service Area, the Allowable Amount is based on the Participating Pharmacy contract rate.Brand Name Drug means a drug or product manufactured by a single manufacturer as defined by a nationally recognized Provider of drug product database information.
To reimburse HMO to the extent of the Allowable Amount that would have been charged to You for health care services if You were not covered under this Certificate.