Enrollee Pays definition

Enrollee Pays means a Member’s financial obligation for services, calculated as the difference between the amount shown as the ‘Accepted Fee’ and the portion shown as ‘Delta Dental Pays’ on the claims statement when a claim is processed.
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Examples of Enrollee Pays in a sentence

  • Beneficiary Out-of-Pocket Spending Enrollee Pays 5% Enr ollee P ays47.5% Brand Drug Costs 72% Generic Drug Costs$6,455 in Total Drug Costs ($4,550 out of pocket)Enrollee Pays 25% Initial CoverageLimit$2,850 in Total Drug Costs ($945 out of pocket)$310 DeductibleFigure 2.

  • In-Network Out-of-Network Annual Deductible Individual $300 $1,200 Family $600 $2,100 CoPayments Plan Pays 90% 65% Enrollee Pays 10% 35% Out-of-Pocket Maximum Individual $1,000 None Family $2,000 None B.

  • Enrollee Pays 5%Beneficiary Out-of-Pocket Spending $6,153 in Total Drug Costs ($4,350 out of pocket)Enrollee Pays 100%Enrollee Pays 25%$2,700 in Total Drug Costs ($970 out of pocket)$295 Deductible$364 Average Annual PremiumFigure 1.

Related to Enrollee Pays

  • Medicare eligible expenses means expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

  • Enrolled Nurse means an employee:

  • Program participant means an individual certified by the secretary as a program participant under Iowa Code section 9E.3.

  • Covered service means a health care service provided to a

  • Eligible patient means an individual who meets all of the following conditions:

  • Retired Participant means a person who has been a Participant, but who has become entitled to retirement benefits under the Plan.

  • Eligibility Service of an employee means the period or periods of service credited to him under the provisions of Article II for purposes of determining his eligibility to participate in the Plan as may be required under Article III or Article VI.

  • Participating employee means an employee whose election to participate in a Plan has been approved by the employer.

  • Plan Participant means a person who is eligible to receive, and is receiving, a pension benefit from the Plan.

  • Eligible Employee means full-time and part-time employees in the bargaining unit who have completed four hundred and fifty (450) hours of service and who are not prohibited from contributing to the Plan by legislation or the Plan rules because of their age or because they are in receipt of a pension from the Plan.

  • School employee means (1) a teacher, substitute teacher, school administrator, school superintendent, guidance counselor, psychologist, social worker, nurse, physician, school paraprofessional or coach employed by a local or regional board of education or working in a public elementary, middle or high school; or (2) any other individual who, in the performance of his or her duties, has regular contact with students and who provides services to or on behalf of students enrolled in a public elementary, middle or high school, pursuant to a contract with the local or regional board of education.

  • Eligible educational institution means any of the following:

  • School employer means a board of school directors, the

  • Participant has the meaning specified in Section 10.06(d).

  • Disabled Participant with respect to a loan if it has no right to exercise any voting or other control rights with respect to such loan (other than the right to approve amendments to the material economic terms of such loan).

  • Individualized education program or “IEP” means a written statement for a child with a disability as defined in 14 DE Admin. Code 922.

  • Adult basic education means education or instruction

  • Managing Employee means a general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of an institution, organization, or agency.

  • Eligible employer means any municipality with a municipal

  • Qualifying Educational Program means a program at a post-secondary school level of not less than three consecutive weeks duration that requires each student taking the program to spend not less than 10 hours per week on courses or work in that program.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Public employee means an individual holding a position by appointment or employment in the government of this state, in the government of 1 or more of the political subdivisions of this state, in the public school service, in a public or special district, in the service of an authority, commission, or board, or in any other branch of the public service, subject to the following exceptions:

  • Adult education means all education or instruction,

  • Public school employer means a public employer that is the board of a school district, intermediate school district, or public school academy; is the chief executive officer of a school district in which a school reform board is in place under part 5A of the revised school code, 1976 PA 451, MCL 380.371 to 380.376; or is the governing board of a joint endeavor or consortium consisting of any combination of school districts,

  • Former Participant means a person who has been a Participant, but who has ceased to be a Participant for any reason.

  • Administrative employee means an employee who normally supervises persons engaged in office administration, construction, security or maintenance work who are represented by another trade union. This definition includes employees who share a community of interest with “supervisors”.