Coinsurance Amount definition

Coinsurance Amount means the percentage of covered service expenses that you are required to pay when you receive a service. Coinsurance amounts are listed in the Schedule of Benefits. Not all covered services have coinsurance. Complaint means any expression of dissatisfaction expressed to the insurer by the claimant, or a claimant’s authorized representative, about an insurer or its providers with whom the insurer has a contract.

Coinsurance Amount. Semi-Private Hospital Component 100% Drug Component 100% Major Medical Component • Out of Province of Residence Emergency 100% • All Other Major Medical Eligible Expenses 100% Lifetime Maximum: In Province of Residence Unlimited Out of Province of Residence • Major Medical Emergency $1,000,000 • Major Medical Referral $15,000 PARAMEDICAL SERVICES Written Referral Benefit Period by Physician Practitioner Maximum Required * Physiotherapist, *Speech Therapist, *Clinical Psychologist, *Christian Science Practitioner, *Acupuncturist No *Masseur $500. Yes Chiropractor $500. No Naturopath $500. No Osteopath $500. No Podiatrist/Chiropodist $500. No Social Worker $500. No *denotes all parishioners for which the Benefit Period Maximum will be combined Hospitalization: Semi-Private Private Duty Nursing: $10,000 per individual, in any Benefit Period. Hearing Aids: $500. per individual in each 5 year period. Drugs: Prescription Vision Care: $100 in any consecutive 24 month period. Schedule of Benefits (Cont'd.) Convalescent Hospital: Daily limit $20 for a maximum period of 120 days Benefit Period: From the Effective Date of the Policy to the first Policy Anniversary and each successive 12 month period thereafter. Survivor Benefit: Termination: 24 months Age 70 or prior retirement. DENTAL Deductible Amount: Single $25 Family $50 Coinsurance: Basic Restorative and Periodontics- Endodonctics 100% Major Restorative 50% Orthodontics 50% Benefit Period Maximum: Basic Restorative and Periodontics- Endodontics $1,500 Major Restorative $1,000 Lifetime Maximum: Orthodontics $1,500 Dental Fee Guide: Current Ontario Dental Association Fee Guide for General Practitioners. Survivor Benefit: 24 months Benefit Period: From the Effective Date of the Policy to the first Policy Anniversary and each successive 12 month period thereafter. Dental Recall Frequency: 5 months Orthodontic Termination: Dependant Child's 20th birthday Termination: Age 70 or prior retirement. Schedule of Benefits (Cont'd.) Married employees pay $ 35.00/pay , single employees pay $ 25.00/pay LETTER OF UNDERSTANDING BETWEEN: A.D. Xxxxxxx Xxxx and International Association of Machinists and Aerospace Workers Thunder Bay Lodge 1120 Re: Part Time Worker The Union agrees to one (1) part time worker who will assist in the office and clerical position and who will not work more than fifteen (15) hours/week except for the purpose of training, lack of qualified employee reasonably available, relief, or in an emergency (act ...

Coinsurance Amount means the dollar amount (expressed as a percentage) of Eligible Dental Expenses incurred by a Participant during a Calendar Year that exceeds benefits provided under the Plan.

Examples of Coinsurance Amount in a sentence

• Coinsurance Amount means the dollar amount expressed as a percentage of Eligible Expenses incurred by a Participant during a Calendar Year that exceeds benefits provided under the Plan.

• A separate Copayment Amount and/or Coinsurance Amount will apply to each fill of a prescription purchased on the same day for insulin and insulin syringes.

• Covered Drugs purchased form a non-Participating Pharmacy, may be subject to Copayment Amount, Coinsurance Amount, Deductibles or dollar maximums, if applicable.

• This may result in a significantly higher Coinsurance Amount to the Member for these Covered Services.

• However, if the Member obtains Covered Services outside of the Blue Cross Blue Shield of Wyoming service area, the local Blue Cross Blue Shield Plan’s (Host Plan’s) contract with the Healthcare Provider may require that the Coinsurance Amount be based on the full amount of the Healthcare Provider’s billed charges rather than the Maximum Allowable Amount.

• Blue Cross Blue Shield of Wyoming calculates a Member’s Coinsurance Amount, when Member obtains the Covered Services from Healthcare Providers in Blue Cross Blue Shield of Wyoming’s service area, off of the Maximum Allowable Amount.

• The Plan will reimburse you for Covered Drugs and covered vaccinations equal to:• the Coinsurance Amount indicated on your Schedule of Coverage,• less the appropriate Copayment Amount, and• less any pricing differences that may apply to the Covered Drug or covered vaccination you receive.

• However, if a Member contacts Blue Cross Blue Shield of Wyoming prior to incurring out‐of‐area Healthcare Services, a Blue Cross Blue Shield of Wyoming member services representative may be able to provide the Member with more specific information on the applicable Coinsurance Amount.

• Each prescription or refill is subject to the Copayment Amount, Coinsurance Amount and any Deductible shown in your Schedule of Coverage and any applicable pricing differences.

• Copayment Amounts do not accumulate toward the Member’s satisfaction of the Deductible Amount or Coinsurance Amount, but will accumulate toward the Member’s satisfaction of the Out‐of‐Pocket Maximum.

More Definitions of Coinsurance Amount

Coinsurance Amount means the percentage of Usual and Customary expenses paid for by the secondary insurance eligible expenses.

Coinsurance Amount means the cumulative dollar amount of Eligible Expenses incurred by a Participant during a Calendar Year to be applied toward the Coinsurance Amount Stop-Loss benefits as described in the “Coinsurance Stop- Loss” section in Article IV of this Contract.

Coinsurance Amount means the percentage amount paid by you for each Prescription Order filled or refilled through a Participating Phar­ macy or non‐Participating Pharmacy.