Copayment Maximum definition

Copayment Maximum means the maximum amount of Copayments a Member is required to pay for Covered Services in a Calendar Year in order for full benefits to be payable for Covered Services obtained after the Calendar Year Copayment Maximum is met. For the remainder of the Calendar Year, no further Copayments are required. The Calendar Year Copayment Maximum does not include charges for services that are not Covered Services, services that are not Prior Authorized through the CO-OP’s Care Management Program when required, or charges in excess of the stated Covered Service benefit maximums as set forth in Attachment A Benefit Schedule.
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Copayment Maximum means the maximum amount of Copayments a Member is required to pay for Covered Services in a Calendar Year in order for full benefits to be payable for Covered Services obtained after the Calendar Year Copayment Maximum is met. For the remainder of the Calendar Year, no further Copayments are required. The Calendar Year Copayment Maximum does not include charges for services that are not Covered Services, services that are not Prior Authorized through HPN’s Managed Care Program, or charges in excess of the stated Covered Service benefit maximums as set forth in Attachment A Benefit Schedule.
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Examples of Copayment Maximum in a sentence

  • The Copayment Maximum and the Out-of-Pocket Maximum, if applicable, are provided in the Summary of Services and Cost Shares in the EOC.

  • Once you meet the Annual Copayment Maximum you are no longer responsible for Cost Share amounts for eligible covered Services, unless otherwise noted under the When You Pay More section of this chapter.

  • See the Benefit Summary section in the front of this Guide to see what your Annual Copayment Maximum amount is.

  • You are responsible for these amounts even after you have met your Annual Copayment Maximum.

  • When You Pay MoreThe following amounts do not apply toward meeting the Annual Copayment Maximum.

  • Annual Copayment MaximumDefinitionThe Annual Copayment Maximum is the maximum amount you pay out of your pocket in a year.

  • The Rx Copayment and Rx Coinsurance set forth above will continue to apply even after the Copayment Maximum in your EOC has been met.

  • Cost Shares set forth in this Rider do not apply toward the Copayment Maximum set forth in the Summary of Services and Cost Shares in your EOC to which this Rider is attached.

  • Once you meet the Annual Copayment Maximum you are no longer responsible for Cost Share amounts for eligible covered Services, unless otherwise noted under the When You Pay More section of this chapter.See the Benefit Summary section in the front of this Guide to see what your Annual Copayment Maximum amount is.When You Pay MoreThe following amounts do not apply toward meeting the Annual Copayment Maximum.

  • Annual Copayment Maximum‌DefinitionThe Annual Copayment Maximum is the maximum amount you pay out of your pocket in a year.

Related to Copayment Maximum

  • Copayment means that you pay a fixed amount each time you fill a prescription.

  • Daily Maximum Limit means the maximum allowable discharge of a pollutant during a calendar day. Expressed as units of mass, the daily discharge is cumulative mass discharged over the course of the day. Expressed as a concentration, it is the arithmetic average of all measurements taken that day.

  • Maximum Limit means that number of issued Shares representing 10% of the total number of issued Shares as at the date of the passing of this Resolution (excluding any Shares which are held as treasury shares as at that date); and

  • Daily Maximum discharge limitation means the highest allowable “daily discharge” during the calendar month.

  • Premium payment plan means a benefit plan whereby state and

  • 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.

  • Payment Cap For each Mortgage Loan, the percentage limit set forth in the related Mortgage Note concerning the maximum permitted increase in a monthly payment.

  • Daily Maximum Cash Amount means, with respect to the conversion of any Note, the quotient obtained by dividing (A) the Specified Dollar Amount applicable to such conversion by (B) forty (40).

  • Maximum means an actual NAV figure of 110% of the Target NAV. In the event Granite elects to declare a special distribution in certain circumstances, the NAV per unit shall be adjusted by any cash component of such special distribution.

  • Extra Premium means an additional amount charged by Us, as per Our Underwriting Policy, which is determined on the basis of disclosures made by You in the Proposal Form or any other information received by Us including medical examination report of the Life Insured.

  • Total maximum daily load or "TMDL" means the sum of the individual wasteload allocations for point sources, load allocations (LAs) for nonpoint sources, natural background loading and a margin of safety. TMDLs can be expressed in terms of either mass per time, toxicity, or other appropriate measure. The TMDL process provides for point versus nonpoint source trade-offs.

  • Deductible has the meaning set forth in Section 11.1(e).

  • Bag limit means the maximum number of game animals, game

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  • Applicable Share Limit means a number of Shares equal to (A) the minimum number of Shares that could give rise to reporting or registration obligations or other requirements (including obtaining prior approval from any person or entity) of a Dealer Person, or could result in an adverse effect on a Dealer Person, under any Applicable Restriction, as determined by Dealer in its reasonable discretion, minus (B) 1% of the number of Shares outstanding.

  • Maximum allowable cost means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a drug.

  • Payment month means, for all programs except EA, the calendar month for which benefits are issued.

  • Bankruptcy Loss Coverage Amount As of any date of determination, the Bankruptcy Loss Coverage Amount shall equal the Initial Bankruptcy Loss Coverage Amount as reduced by (i) the aggregate amount of Bankruptcy Losses allocated to the Certificates since the Cut-off Date and (ii) any permissible reductions in the Bankruptcy Loss Coverage Amount as evidenced by a letter of each Rating Agency to the Trustee to the effect that any such reduction will not result in a downgrading, qualification or withdrawal of the then current ratings assigned to the Classes of Certificates rated by it.

  • High Deductible Health Plan means a Health Plan as defined by 26 USC § 223(c)(2)(A) that also is a Qualified Health Plan.

  • Premium pay Per the statute, recipients have broad latitude to designate critical infrastructure sectors and make grants to third-party employers for the purpose of providing premium pay or otherwise respond to essential workers. While the interim final rule generally preserves the flexibility in the statute, it does add a requirement that recipients give written justification in the case that premium pay would increase a worker’s annual pay above a certain threshold. To set this threshold, Treasury analyzed data Federal Register / Vol. 86, No. 93 / Monday, May 17, 2021 / Rules and Regulations 26817 from the Bureau of Labor Statistics to determine a level that would not require further justification for premium pay to the vast majority of essential workers, while requiring higher scrutiny for provision of premium pay to higher- earners who, even without premium pay, would likely have greater personal financial resources to cope with the effects of the pandemic. Treasury believes the threshold in the interim final rule strikes the appropriate balance between preserving flexibility and helping encourage use of these resources to help those in greatest need. The interim final rule also requires that eligible workers have regular in-person interactions or regular physical handling of items that were also handled by others. This requirement will also help encourage use of financial resources for those who have endured the heightened risk of performing essential work.

  • Maximum Loan Amount has the meaning set forth in Section 2.1(a).

  • Deductible Amount means, with respect to any Insuring Agreement, the amount set forth under the heading “Deductible Amount” in Item 3 of the Declarations or in any Rider for such Insuring Agreement, applicable to each Single Loss covered by such Insuring Agreement.

  • Premium tax means a tax paid by insurance companies to provincial and territorial governments calculated as a percentage of gross premiums written.

  • Individual PAGA Payment means the Aggrieved Employee’s pro rata share of 25% of the PAGA Penalties calculated according to the number of Workweeks worked during the PAGA Period.

  • Aggregate Limit shall have the meaning assigned to such term in Section 1.1 hereof.

  • Minimum qualifications” are qualifications mandated for the position and which must be possessed by a Unit Member before the individual can be considered for employment in a specific classification.