{"component": "definition", "props": {"groups": [{"samples": [{"hash": "9llLdQ2kyrT", "uri": "https://edge.sitecorecloud.io/bluecross-6f8ea2ea/media/project/bcbs-az/benefit-books-and-sbcs/employer/resources/documents-grandfathered-2022/bluepreferred-saver-100-ppo-51-to-99.pdf", "label": "edge.sitecorecloud.io", "score": 8.9000682831, "published": false}, {"hash": "dJDESAHV7PM", "uri": "https://edge.sitecorecloud.io/bluecross-6f8ea2ea/media/project/bcbs-az/benefit-books-and-sbcs/employer/resources/documents-grandfathered-2022/bluepreferred-no-copay-ppo-2-to-50.pdf", "label": "edge.sitecorecloud.io", "score": 8.9000682831, "published": false}, {"hash": "4o6CiDYYUQc", "uri": "https://edge.sitecorecloud.io/bluecross-6f8ea2ea/media/project/bcbs-az/benefit-books-and-sbcs/employer/resources/documents-grandfathered-2022/bluepreferred-copay-ppo-51-to-99.pdf", "label": "edge.sitecorecloud.io", "score": 8.9000682831, "published": false}], "size": 62, "snippet_links": [{"key": "amount-of-reimbursement", "type": "clause", "offset": [16, 39]}, {"key": "allocated-to", "type": "definition", "offset": [40, 52]}, {"key": "covered-service", "type": "clause", "offset": [55, 70]}, {"key": "member-cost", "type": "definition", "offset": [116, 127]}, {"key": "share-payment", "type": "clause", "offset": [128, 141]}, {"key": "deductible-and-coinsurance", "type": "clause", "offset": [161, 187]}, {"key": "based-on", "type": "definition", "offset": [188, 196]}, {"key": "access-fees", "type": "clause", "offset": [226, 237]}, {"key": "coinsurance-maximum", "type": "definition", "offset": [337, 356]}, {"key": "to-the-member", "type": "clause", "offset": [395, 408]}, {"key": "benefit-plan", "type": "definition", "offset": [411, 423]}], "snippet": "means the total amount of reimbursement allocated to a covered Service and includes both the BCBSAZ payment and the Member Cost-share payment. BCBSAZ calculates deductible and Coinsurance based on the Allowed Amount, less any access fees or Precertification Charges. BCBSAZ uses the Allowed Amount to accumulate toward any Out-of-pocket Coinsurance Maximum or Out-of-pocket Maximum that applies to the member\u2019s Benefit Plan. The Allowed Amount does not include any balance bills from noncontracted Providers. The Allowed Amount is neither tied to, nor necessarily reflective of, the amounts Providers in any given area usually charge for their services. The table below shows how BCBSAZ determines the Allowed Amount:", "hash": "47382badaff655f5e391d3cbbedad638", "id": 1}, {"samples": [{"hash": "lTLiknnAlVg", "uri": "/contracts/lTLiknnAlVg#allowed-amount", "label": "Medical and Hospital Service Contract", "score": 26.4702262878, "published": true}, {"hash": "jalBL7RVfjB", "uri": "/contracts/jalBL7RVfjB#allowed-amount", "label": "Medical and Hospital Service Contract", "score": 26.4702262878, "published": true}, {"hash": "iXv3f2hEgM1", "uri": "/contracts/iXv3f2hEgM1#allowed-amount", "label": "Medical and Hospital Service Contract", "score": 26.4702262878, "published": true}], "size": 52, "snippet_links": [{"key": "maximum-amount", "type": "definition", "offset": [10, 24]}, {"key": "services-rendered", "type": "definition", "offset": [91, 108]}, {"key": "participating-providers", "type": "definition", "offset": [112, 135]}, {"key": "at-any-time", "type": "clause", "offset": [171, 182]}, {"key": "notice-to-you", "type": "clause", "offset": [191, 204]}, {"key": "your-consent", "type": "clause", "offset": [208, 220]}], "snippet": "means the maximum amount established by AvMed upon which payment will be based for Covered Services rendered by Participating Providers. The Allowed Amount may be changed at any time without notice to you or your consent.", "hash": "3b3ad569fba27bb870abe2d5ce4b3154", "id": 2}, {"samples": [{"hash": "ixzFcLJXgYj", "uri": "https://www.bsneny.com/content/dam/bsneny/broker-employer/public/our-health-plans/off-exchange/dental/2020/2020-neny-off-exchange-pediatric.pdf", "label": "www.bsneny.com", "score": 8.0540723801, "published": false}, {"hash": "iFy2dKzO3zI", "uri": "https://www.bsneny.com/content/dam/bsneny/broker-employer/public/our-health-plans/off-exchange/dental/2019/CD1C3S0455_0418_NENY_PPO_BlueValue2_Group_OFF%20_noAge29.pdf", "label": "www.bsneny.com", "score": 7.507871151, "published": false}, {"hash": "1qwivdPTPte", "uri": "https://www.bcbswny.com/content/dam/BCBSWNY/broker-group/public/our-health-plans/off-exchange/dental/2019/CD1C3S0455_0418_WNY_PPO_BlueValue3_Group_OFF_noAge29.pdf", "label": "www.bcbswny.com", "score": 7.507871151, "published": false}], "size": 50, "snippet_links": [{"key": "maximum-amount", "type": "definition", "offset": [10, 24]}, {"key": "for-the-services", "type": "clause", "offset": [37, 53]}, {"key": "applicable-copayment", "type": "clause", "offset": [109, 129]}, {"key": "deductible-and-coinsurance", "type": "clause", "offset": [131, 157]}], "snippet": "means the maximum amount We will pay for the services or supplies covered under this Certificate, before any applicable Copayment, Deductible and Coinsurance amounts are subtracted. We determine Our Allowed Amount as follows:", "hash": "0cdac14c708a87ba5d2089d9f87faafb", "id": 3}, {"samples": [{"hash": "lr3zcQpjHwn", "uri": "/contracts/lr3zcQpjHwn#allowed-amount", "label": "Preferred Provider Organization Insurance Contract", "score": 26.6591377258, "published": true}, {"hash": "kEfuA8ZF7VH", "uri": "/contracts/kEfuA8ZF7VH#allowed-amount", "label": "Preferred Provider Organization Insurance Contract", "score": 26.6591377258, "published": true}, {"hash": "ipP56051W3C", "uri": "/contracts/ipP56051W3C#allowed-amount", "label": "Preferred Provider Organization Insurance Contract", "score": 26.6591377258, "published": true}], "size": 50, "snippet_links": [{"key": "maximum-amount", "type": "definition", "offset": [10, 24]}, {"key": "for-the-services", "type": "clause", "offset": [37, 53]}, {"key": "under-this-contract", "type": "clause", "offset": [74, 93]}, {"key": "applicable-copayment", "type": "clause", "offset": [106, 126]}, {"key": "deductible-and-coinsurance", "type": "clause", "offset": [128, 154]}, {"key": "participating-providers", "type": "definition", "offset": [246, 269]}, {"key": "the-participating", "type": "clause", "offset": [313, 330]}, {"key": "for-non", "type": "clause", "offset": [360, 367]}, {"key": "for-providers", "type": "clause", "offset": [423, 436]}, {"key": "based-on", "type": "definition", "offset": [475, 483]}, {"key": "fee-schedule", "type": "definition", "offset": [511, 523]}], "snippet": "means the maximum amount We will pay for the services or supplies covered under this Contract; before any applicable Copayment, Deductible and Coinsurance amounts are subtracted. We determine Our Allowed Amount as follows: The Allowed Amount for Participating Providers will be the amount we have negotiated with the Participating Provider. The Allowed Amount for Non-Participating Providers will be determined as follows: For Providers, the Allowed Amount will be an amount based on Our Participating Provider fee schedule or rate.", "hash": "28a6cf0b5af62a7cbb24d009d1632d8d", "id": 4}, {"samples": [{"hash": "f96vwfFlpWC", "uri": "https://lawfilesext.leg.wa.gov/biennium/2023-24/Pdf/Bills/House%20Bills/2285.pdf?q=20240424100436", "label": "lawfilesext.leg.wa.gov", "score": 18.7473106384, "published": false}, {"hash": "fd0SLwkQ2te", "uri": "https://www.insurance.wa.gov/sites/default/files/2020-09/cr-102-r-2020-07.pdf", "label": "Notice", "score": 14.3634500504, "published": false}, {"hash": "j7wqBGSEIFT", "uri": "https://lawfilesext.leg.wa.gov/biennium/2023-24/Pdf/Bills/Session%20Laws/Senate/5986-S.SL.pdf", "label": "lawfilesext.leg.wa.gov", "score": 12.1156740189, "published": false}], "size": 36, "snippet_links": [{"key": "billed-charge", "type": "definition", "offset": [31, 44]}], "snippet": "means the maximum portion of a billed charge", "hash": "7019a36d21d380d571b6d43df70f7f38", "id": 5}, {"samples": [{"hash": "408F617RwMm", "uri": "https://www.sec.gov/Archives/edgar/data/4611/000117152004000448/ex99-1.txt", "label": "Collateral Trust Agreement (American Biltrite Inc)", "score": 9.0, "published": false}, {"hash": "lqhq2Jr5T4f", "uri": "https://www.sec.gov/Archives/edgar/data/23341/000117152004000446/ex99-2.txt", "label": "Collateral Trust Agreement (Congoleum Corp)", "score": 9.0, "published": false}, {"hash": "lbQnWRewGhK", "uri": "http://bankrupt.com/misc/pawb17-70164-231.pdf", "label": "bankrupt.com", "score": 8.9164953232, "published": false}], "size": 31, "snippet_links": [], "snippet": "means the sum at which a Claim is Allowed.", "hash": "c08b69af94f0e58f673fa9f324fa6129", "id": 6}, {"samples": [{"hash": "eKOfzPYNTeG", "uri": "https://www.surpriseaz.gov/DocumentCenter/View/34546/PPO--Benefit-Book?bidId=", "label": "www.surpriseaz.gov", "score": 10.1704311371, "published": false}, {"hash": "lErFqrDNmb", "uri": "https://www.surpriseaz.gov/DocumentCenter/View/34543/HMO--Benefit-Book", "label": "www.surpriseaz.gov", "score": 10.1704311371, "published": false}, {"hash": "dEFnSkQQQct", "uri": "https://www.surpriseaz.gov/DocumentCenter/View/2196/PPO-Benefit-Plan-Booklet", "label": "www.surpriseaz.gov", "score": 10.1704311371, "published": false}], "size": 29, "snippet_links": [{"key": "amount-of-reimbursement", "type": "clause", "offset": [16, 39]}, {"key": "allocated-to", "type": "definition", "offset": [40, 52]}, {"key": "covered-service", "type": "clause", "offset": [55, 70]}, {"key": "member-cost", "type": "definition", "offset": [116, 127]}, {"key": "share-payment", "type": "clause", "offset": [128, 141]}], "snippet": "means the total amount of reimbursement allocated to a covered service and includes both the BCBSAZ payment and the member cost-share payment.", "hash": "a5d0682406abec0553ed61367ddf178e", "id": 7}, {"samples": [{"hash": "bIUDSsg60mb", "uri": "https://dr201.s3.amazonaws.com/fre/Confirmation%20Order.pdf", "label": "dr201.s3.amazonaws.com", "score": 10.8316221237, "published": false}, {"hash": "6apEq2K4F51", "uri": "https://dr201.s3.amazonaws.com/fre/Third%20Amended%20Disclosure%20Statement.pdf", "label": "dr201.s3.amazonaws.com", "score": 10.7686519623, "published": false}, {"hash": "1Luw8ovFzR5", "uri": "https://dr201.s3.amazonaws.com/fre/Third%20Amended%20Plan%20of%20Liquidation.pdf", "label": "dr201.s3.amazonaws.com", "score": 10.7659139633, "published": false}], "size": 29, "snippet_links": [{"key": "dollar-amount", "type": "definition", "offset": [10, 23]}], "snippet": "means the dollar amount in which a Claim is allowed.", "hash": "0a1e81f71363cbd23964d01165c0f236", "id": 8}, {"samples": [{"hash": "45wHaSiC2k9", "uri": "https://lawfilesext.leg.wa.gov/law/wsrpdf/2024/21/24-21-152.pdf", "label": "lawfilesext.leg.wa.gov", "score": 19.5341014862, "published": false}, {"hash": "1aodesSbaOw", "uri": 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provider or facility or by a nonparticipating provider or facility.", "hash": "633646d8add9636d8f4c4301e7d647a0", "id": 9}, {"samples": [{"hash": "6dy9DIwA3xj", "uri": "https://www.wship.org/Docs/2024%20PREFERRED%20Provider%20Plan%20Policy_clean.pdf", "label": "www.wship.org", "score": 18.0784835815, "published": false}, {"hash": "94gVOLD5npx", "uri": "https://www.wship.org/Docs/2024%20HSA%20Quallified%20PPO%20Plan%20Policy_clean.pdf", "label": "www.wship.org", "score": 11.7556467056, "published": false}, {"hash": "2Lo2oetVyGp", "uri": "https://www.wship.org/Docs/2023%20PREFERRED%20Provider%20Plan%20Policy_07.13.2022_no_clean.pdf", "label": "www.wship.org", "score": 11.2642030716, "published": false}], "size": 20, "snippet_links": [{"key": "for-services", "type": "clause", "offset": [7, 19]}, {"key": "network-provider", "type": "clause", "offset": [48, 64]}, {"key": "the-network", "type": "definition", "offset": [99, 110]}, {"key": "covered-service", "type": "clause", "offset": [128, 143]}, {"key": "a-non", "type": "clause", "offset": [184, 189]}, {"key": "maximum-amount", "type": "definition", "offset": [255, 269]}, {"key": "determine-the", "type": "clause", "offset": [388, 401]}, {"key": "any-service", "type": "clause", "offset": [421, 432]}], "snippet": "means, for services or supplies received from a Network Provider, the amount agreed upon by Us and the Network Provider for the Covered Service. For services or supplies received from a non-Network Provider, the Allowed Amount will be no greater than the maximum amount We otherwise would have allowed had the Covered Service been furnished by a Network Provider. We reserve the right to determine the Allowed Amount for any service or supply.", "hash": "d35fd4e0b63f8c0ec98b1bfee52a41f0", "id": 10}], "next_curs": "ClsSVWoVc35sYXdpbnNpZGVyY29udHJhY3RzcjcLEhpEZWZpbml0aW9uU25pcHBldEdyb3VwX3Y1NiIXYWxsb3dlZC1hbW91bnQjMDAwMDAwMGEMogECZW4YACAA", "definition": {"size": 824, "title": "Allowed Amount", "snippet": "means the total amount of reimbursement allocated to a covered Service and includes both the BCBSAZ payment and the Member Cost-share payment. BCBSAZ calculates deductible and Coinsurance based on the Allowed Amount, less any access fees or Precertification Charges. BCBSAZ uses the Allowed Amount to accumulate toward any Out-of-pocket Coinsurance Maximum or Out-of-pocket Maximum that applies to the member\u2019s Benefit Plan. The Allowed Amount does not include any balance bills from noncontracted Providers. The Allowed Amount is neither tied to, nor necessarily reflective of, the amounts Providers in any given area usually charge for their services. The table below shows how BCBSAZ determines the Allowed Amount:", "id": "allowed-amount", "examples": ["In addition to Cost-Sharing, You will also be responsible for paying any difference between the <strong>Allowed Amount</strong> and the Non-Participating Provider\u2019s charge.", "See the Cost-Sharing Expenses and <strong>Allowed Amount</strong> section of this Contract for a description of how We calculate the <strong>Allowed Amount</strong>.", "You must pay the amount of the Non-Participating Provider\u2019s charge that exceeds Our <strong>Allowed Amount</strong>.", "Any charges of a Non-Participating Provider that are in excess of the <strong>Allowed Amount</strong> do not apply towards the Deductible or Out-of-Pocket Limit.", "The <strong>Allowed Amounts</strong> provision near the end of this Schedule of Benefits will tell you when you are responsible for amounts that exceed the <strong>Allowed Amount</strong>.", "However, when the <strong>Allowed Amount</strong> for a service is less than the Copayment, You are responsible for the lesser amount.", "Except where stated otherwise, after You have satisfied the Deductible described above, You must pay a percentage of the <strong>Allowed Amount</strong> for Covered Services.", "Coverage for Emergency services at a non-Network Facility is limited to the <strong>Allowed Amount</strong>.", "This is the fixed dollar amount (Copayment) or percentage (Coinsurance) of the <strong>Allowed Amount</strong> or Maximum Allowable Payment you have to pay when you receive these services.", "Expenses are considered an <strong>Allowed Amount</strong> if the charges are consistent with those normally charged to others by the provider or organization for the same services or supplies; and the charges are within the general range of charges made by other providers in the same geographical area for the same services or supplies."], "related": [["mo-amount", "M&O Amount", "M&amp;O Amount"], ["subordination-reduction-amount", "Subordination Reduction Amount", "Subordination Reduction Amount"], ["total-distribution-amount", "Total Distribution Amount", "Total Distribution Amount"], ["allowed-claim", "Allowed Claim", "Allowed Claim"], ["allocated-amount", "Allocated Amount", "Allocated Amount"]], "related_snippets": [], "updated": "2025-08-02T05:42:56+00:00"}, "json": true, "cursor": ""}}