Lifetime Maximum means the maximum lifetime total benefits (fixed dollar amount) for designated covered procedures.
Lifetime Maximum. The maximum value of benefits provided for Covered Services under the Agreement after which benefits under the Agreement are no longer available as set forth in the Allowances Schedule. The value of Covered Services is based on the Fee Schedule, as defined above. The lifetime maximum applies to this Agreement or in combination with any other medical coverage agreement between GHC and Group. Medical Condition: A disease, illness or injury. Medically Necessary: Appropriate and clinically necessary services, as determined by GHC’s Medical Director, or his/her designee, according to generally accepted principles of good medical practice, which are rendered to a Member for the diagnosis, care or treatment of a Medical Condition and which meet the standards set forth below. In order to be Medically Necessary, services and supplies must meet the following requirements: (a) are not solely for the convenience of the Member, his/her family or the provider of the services or supplies; (b) are the most appropriate level of service or supply which can be safely provided to the Member; (c) are for the diagnosis or treatment of an actual or existing Medical Condition unless being provided under GHC’s schedule for preventive services; (d) are not for recreational, life-enhancing, relaxation or palliative therapy, except for treatment of terminal conditions; (e) are appropriate and consistent with the diagnosis and which, in accordance with accepted medical standards in the State of Washington, could not have been omitted without adversely affecting the Member’s condition or the quality of health services rendered; (f) as to inpatient care, could not have been provided in a provider’s office, the outpatient department of a hospital or a non-residential facility without affecting the Member’s condition or quality of health services rendered; (g) are not primarily for research and data accumulation; and (h) are not experimental or investigational. The length and type of the treatment program and the frequency and modality of visits covered shall be determined by GHC’s Medical Director, or his/her designee. In addition to being medically necessary, to be covered, services and supplies must be otherwise included as a Covered Service as set forth in Section IV. of the Agreement and not excluded from coverage. The cost of non-covered services and supplies shall be the responsibility of the Member. Medicare: The federal health insurance program for the aged and disabled.
Lifetime Maximum. The maximum value of benefits provided for Covered Services under the Agreement after which benefits under the Agreement are no longer available as set forth in the Allowances Schedule. The value of Covered Services is based on the Fee Schedule, as defined above. Medical Condition: A disease, illness or injury. Medically Necessary: Appropriate and clinically necessary services, as determined by GHC’s Medical Director, or his/her designee, according to generally accepted principles of good medical practice, which are rendered to a Member for the diagnosis, care or treatment of a Medical Condition. Services must be medically and clinically necessary for benefits to be covered under the Agreement. The cost of services and supplies, which are not Medically Necessary shall be the responsibility of the Member. In order to be Medically Necessary, services and supplies must meet the following requirements: (a) are not solely for the convenience of the Member, his/her family or the provider of the services or supplies;
Examples of Lifetime Maximum in a sentence
Adjustable Rate Mortgages (ARMs) Numeric – Decimal 0.02 9.999999 ARMs Only >= 0 and <= 1 99=no cap 51 Lifetime Maximum Rate (Ceiling) The maximum interest rate that can be in effect during the life of the loan.
Essential Health Benefits Covered Services are not subject to the Lifetime Maximum.
See the Schedule of Benefits to determine if there is a Lifetime Maximum for Covered Services that are not Essential Health Benefits.
Lifetime Maximum means the maximum dollar amount payable toward a Member's claims for Covered Services while the Member is covered under this Group Contract.
The Lifetime Maximum includes all benefit maximums specified in the Plan, including those specified in the Schedule of Benefits.
More Definitions of Lifetime Maximum
Lifetime Maximum means the maximum dollar amount payable toward a Member's claims for Covered Services while the Member is insured under this Group Contract. See the Description of Covered Services and the Schedule of Benefits for specific information as to how the Lifetime Maximum, if any, applies to the benefits under the Group Contract.
Lifetime Maximum means the maximum that Unum will pay you for all long term care benefits. You have your own Lifetime Maximum.
Lifetime Maximum means the maximum benefit payable during an individual’s lifetime while covered under this Plan. The Plan may provide a Lifetime Maximum benefit for specific types of medical treatment. The Lifetime Maximums will be shown in the applicable Schedule of Benefits.
Lifetime Maximum means the maximum dollar amount payable toward a Member's claims for Covered Services while the Member is covered under this Group Contract. Essential Health Benefits Covered Services are not subject to the Lifetime Maximum. See the Schedule of Benefits to determine if there is a Lifetime Maximum for Covered Services that are not Essential Health Benefits.
Lifetime Maximum means the maximum benefit payable toward covered expenses incurred by an individual during his or her lifetime under the policy. Lifetime maximums are a common feature among orthodontic policies.
Lifetime Maximum. The maximum amount the Plan Administrator will pay on behalf of the Covered Plan Participant during his lifetime. The Covered Services to which a Lifetime Maximum applies are shown in the Schedule of Benefits. Medically Necessary (or “Medical Necessity”) – Dental care services, treatment, procedures, equipment, drugs, devices, items or supplies that a Provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are:
Lifetime Maximum means the maximum liability of the Plan as set forth in the Schedule of Benefits, with respect to each Participant.