Covered charges definition

Covered charges means billed charges that represent medically necessary, reasonable, and customary items of expense for covered services that meet medical review criteria of AHCCCS or a contractor.

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Covered charges means the Maximum Allowable Amount for a Reasonable, Medically Necessary service, treatment or supply, meant to improve a condition or Covered Person’s health, which is eligible for coverage in this Plan. Covered Charges will be determined based upon all other Plan provisions. When more than one treatment option is available, and one option is no more effective than another, the Covered Charges is the least costly option that is no less effective than any other option.

Covered charges means the dollar amount a health care provider bills a Member or Wellmark for Covered Services in accordance with the terms of the Benefits Document.

Examples of Covered charges in a sentence

• Coinsurance is the percentage of Covered charges that you and your Covered Dependents must pay directly to the In-network Practitioner/Provider for Covered Services after the Annual Contract Year Deductible has been met.

• PHP pays 100 percent (100%) of Covered charges after the Out-of-pocket Maximum is met.

• Covered charges related to an emergency admission to a non-network provider will be paid up to twenty-five thousand dollars ($25,000) with the normal plan deductible and coinsurance (if applicable).

• Covered charges for In-network Practitioner and Provider services only apply to the In-network Coinsurance and Annual Out-of-pocket Maximum limits and do not apply to the Out-of- network Coinsurance and Annual Out-of-pocket Maximum shown on the Summary of Benefits and Coverage.

• Covered charges above $1,700.00 will be paid 100% by the Plan under the reasonable charge standard, subject to Plan limitations.

More Definitions of Covered charges

Covered charges means billed charges that represent medically necessary, reasonable, and customary items of expense for Title XXI covered services that meet medical review criteria of the Administration or contractor.

Covered charges means eligible expenses that are incurred by the Insured Person for Medically Necessary services, supplies, care, or treatment for a Covered Diving Accident. The Accident must occur while Coverage is in force. Eligible expenses must be incurred within 365 days of the Accident.

Covered charges means the Allowable Expense for the Medically Necessary treatment of conditions covered under the Plan.

Covered charges means billed charges submitted to the department on a claim by the provider, less the noncov- ered charges indicated on the claim.

Covered charges means billed charges that represent medi- cally necessary, reasonable, and customary items of expense for covered services that meet medical review criteria of AHC- CCS or a contractor.

Covered charges means billed charges that represent medi- cally necessary, reasonable, and customary items of expense for Title XXI-covered services that meet medical review crite- ria of the Administration or contractor.

Covered charges means the reasonable and customary charges which are incurred for the medically necessary treatment of conditions that are covered under the Plan.