Allowable Benefit definition

Allowable Benefit as used in this subsection, means the total charge for a service or supply specified in this Agreement for which benefits will be provided, to the extent that such service or supply is covered by this and/or the Other Contract.
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Allowable Benefit means a benefit relating to medical, surgical, or hospital care in the event of
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Allowable Benefit means a benefit to provide medical, surgical, or hospital care or benefits.
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Examples of Allowable Benefit in a sentence

  • This Plan will always pay either its regular benefits in full if it is determined to be the Primary Plan (Plan primarily responsible for payment) or, if the Plan is determined to be the Secondary Plan, a reduced amount which, when added to the benefits payable by the Primary Plan, will equal no more than the Allowable Benefit under This Plan.

  • Maximum Allowable Benefit: The maximum allowable benefit shall mean the benefit payable for a specific coverage item or benefit under this Plan.

  • If the fees of Out-of-Network providers are greater than the amounts paid under your MCTWF Actives Plan and MCTWF Retirees Plan’s Out-of-Network Maximum Allowable Benefit schedule, You will be responsible for paying the balance or the full amount if You have reached your Annual per person maximum.

  • When You use Out-of-Network providers, You are subject to paying any balance over and above the Maximum Allowable Benefit schedule.The Fund is required to furnish You upon request and without charge, a list of its Network of dental providers.

  • Maximum Allowable Benefit: An amount a provider is allow ed for a particular service.

  • B) Maximum Allowable Benefit: The maximum annual benefit paid for this type of disability is equal to the smaller of (1) or (2): 1.

  • B) Maximum Allowable Benefit: The maximum annual benefit paid for this type of disability is equal to 2/3rds (66.67%) of your Average Annual Pay, minus any benefits you receive from Social Security.

  • If the provider does not participate in the BCBS Traditional Network or MultiPlan Network, you will be liable for any provider charges in excess of MCTWF ’s Maximum Allowable Benefit in addition to any required in-network level Deductible, Copayment and Coinsurance amounts.

  • Please see Section 14 for a definition of the Maximum Allowable Benefit.

  • If the provider does not participate in the BCBS Traditional Network or MultiPlan Network, you may be subject to balance billing for charges in excess of MCTWF’s Maximum Allowable Benefit schedule, in addition to any in-network level Deductible, Copayment and Coinsurance amounts.


More Definitions of Allowable Benefit

Allowable Benefit means a benefit relating to medical, surgical, or hospital care in the event of sickness, accident, disability, or any combination of sickness, accident, or disability.
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Related to Allowable Benefit

  • Allowable Amount on any date, means:

  • Allowable Grace Period shall have the meaning assigned to such term in Section 3(p).

  • Professional Fee Amount means the aggregate amount of Professional Fee Claims and other unpaid fees and expenses that Professionals estimate they have incurred or will incur in rendering services to the Debtors prior to and as of the Confirmation Date, which estimates Professionals shall deliver to the Debtors as set forth in Article II.B of the Plan.

  • Allowable means those costs that are reasonable and allocable, and that conform to any limitations set forth in the approved proposal.

  • Advanced practice nurse means a person who holds current certification as nurse practitioner/clinical nurse specialist from the State Board of Nursing.

  • Maximum Allowable Payment means the maximum amount, as established by AvMed, which AvMed will pay for any Covered Service rendered by a Non-Participating Provider or supplier of services, medications or supplies, except for Emergency Medical Services and Care as defined herein. The Maximum Allowable Payment may be changed at any time by AvMed without notice to you or your consent.

  • Allowable Expenses means any necessary, reasonable and customary item of expense at least a portion of which is covered under at least one of the Health Benefit Plans covering the person for whom claim is made. When a Health Benefit Plan provides benefits in the form of coverage for services, the reasonable cash value of each service rendered shall be deemed to be both an Allowable Expense and a benefit paid.

  • Allowable Costs means the costs defined as allowable in 42 CFR, Chapter IV, Part 413, as amended to October 1, 2007, except for the purposes of calculating direct medical education costs, where only the reported costs of the interns and residents are allowed. Further, costs are allowable only to the extent that they relate to patient care; are reasonable, ordinary, and necessary; and are not in excess of what a prudent and cost-conscious buyer would pay for the given service or item.

  • Agent Payment Account means account no. 5000000030266 of Agent at Wachovia Bank, National Association, or such other account of Agent as Agent may from time to time designate to Administrative Borrower as the Agent Payment Account for purposes of this Agreement and the other Financing Agreements.

  • Professional Fee Claims means all Administrative Claims for the compensation of Professionals and the reimbursement of expenses incurred by such Professionals through and including the Effective Date to the extent such fees and expenses have not been paid pursuant to the Interim Compensation Order or any other order of the Bankruptcy Court. To the extent the Bankruptcy Court denies or reduces by a Final Order any amount of a Professional’s requested fees and expenses, then the amount by which such fees or expenses are reduced or denied shall reduce the applicable Professional Fee Claim.

  • Professional Fee Claim means a Claim by a professional seeking an award by the Bankruptcy Court of compensation for services rendered or reimbursement of expenses incurred through and including the Confirmation Date under sections 330, 331, 503(b)(2), 503(b)(3), 503(b)(4), or 503(b)(5) of the Bankruptcy Code.

  • Allowable Expense means a necessary, reasonable and customary item of expense for health care, which is: • covered at least in part under one or more plans covering the person for whom the claim is made; and • incurred while this plan is in force. When a plan provides healthcare coverage in the form of services, the reasonable cash value of each service is considered as both an allowable expense and a benefit paid. Vision care services covered under other plans are not considered an allowable expense under this plan. PLAN means any of the following that provides benefits or services for medical, pharmacy, or dental care treatment. If separate contracts are used to provide coordinated coverage for members of a group, the separate contracts are considered parts of the same plan and there is no COB among those separate contracts.

  • Allowable emissions means the emission rate of a stationary source calculated using both the maximum rated capacity of the source, unless the source is subject to federally enforceable limits which restrict the operating rate or hours of operation, and the most stringent of the following:

  • Administrative Expenses means (i) all administrative and operating costs and expenses incurred by the Partnership, (ii) those administrative costs and expenses of the General Partner, including any salaries or other payments to directors, officers or employees of the General Partner, and any accounting and legal expenses of the General Partner, which expenses, the Partners have agreed, are expenses of the Partnership and not the General Partner, and (iii) to the extent not included in clause (ii) above, REIT Expenses; provided, however, that Administrative Expenses shall not include any administrative costs and expenses incurred by the General Partner that are attributable to Properties or partnership interests in a Subsidiary Partnership that are owned by the General Partner directly.

  • Professional Fee Reserve Amount means the total amount of Professional Fee Claims estimated in accordance with Article II.A.2(c) of the Plan.

  • Reimbursement Payment shall have the meaning given to that term in Subparagraph 2.02(c).

  • avoidable costs means those costs which would not be incurred by the Licensee if he did not supply the consumers in question, including (but with due regard to the timing thereof all relevant future outlays affected by the decision to supply; and"terms"means all the terms on which a supply of gas is provided or offered, whether as respects charges, methods of payment or otherwise.

  • prescribed fee means a fee determined by the Council by resolution in terms of section 10G(7)(a)(ii) of the Local Government Transition Act, 1993 (Act No. 209 of 1993), or any other applicable legislation;

  • Rechargeable battery means a sealed nickel-cadmium battery, a sealed lead acid battery, or any other rechargeable battery, except certain dry cell batteries or a battery exempted by the Commissioner of the Pollution Control Agency (PCA) (Commissioner). (Minn. Stat. § 115A.9157)

  • Enforcement Costs means court expenses, reasonable attorney fees of the attorney general, and other reasonable expenses of an executive department that are incurred in relation to enforcement under this part.

  • Enforcement Expenses shall include all reasonable attorneys’ fees, court costs, transcript costs, fees of experts, travel expenses, duplicating costs, printing and binding costs, telephone charges, postage, delivery service fees, and all other out-of-pocket disbursements or expenses of the types customarily incurred in connection with an action to enforce indemnification or advancement rights, or an appeal from such action. Expenses, however, shall not include fees, salaries, wages or benefits owed to Indemnitee.

  • Administrative Expense Claim means any right to payment constituting a cost or expense of administration of the Chapter 11 Cases under sections 503(b) and 507(a)(2) of the Bankruptcy Code including, without limitation, (a) any actual and necessary costs and expenses of preserving the Estates, (b) all compensation and reimbursement of expenses to the extent Allowed by the Bankruptcy Court under section 330 or 503 of the Bankruptcy Code, (c) any fees or charges assessed against the Estates under section 1930 of chapter 123 of Title 28 of the United States Code, (d) all Claims arising under section 503(b)(9) of the Bankruptcy Code, and (e) the Prepetition Lenders Adequate Protection Claims.

  • Administrative Expense means (a) any cost or expense of administration of the Reorganization Cases under section 503(b) of the Bankruptcy Code including, but not limited to (1) any actual and necessary post-petition cost or expense of preserving the Estates or operating the Debtors' assets and businesses, (2) any payment to be made under the Plan to cure a default on an assumed executory contract or unexpired lease, (3) any post-petition cost, indebtedness or contractual obligation duly and validly incurred or assumed by the Debtors in the ordinary course of business, and (4) compensation or reimbursement of expenses of professionals to the extent allowed by the Bankruptcy Court under section 327, 328, 330(a), 331, 503(b) or 1103 of the Bankruptcy Code, including, without limitation, the Futures Representative and its Representatives and (b) any fee or charge assessed against the Estates under 28 U.S.C. ss. 1930.

  • Allowable Cost means a cost that complies with all legal requirements that apply to a particular federal education program, including statutes, regulations, guidance, applications, and approved grant awards.

  • Allowable Deductions means the following costs, charges, and expenses incurred or accrued by Payor:

  • Licensed health care professional means a person who possesses a professional medical license that is valid in Oregon. Examples include, but are not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant (PA), or occupational therapist (OT).