SHL Reimbursement Schedule definition

SHL Reimbursement Schedule means the schedule showing the amount SHL will pay for Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on: • the amount most consistently paid to the Provider; or • the amount paid to other Providers with the same or similar qualifications; or • the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the geographic market, a gap methodology, or Eligible Medical Expense could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of: • the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or • 100% of the Eligible Medical Expense for Emergency Services provided by a Non-Plan Provider under your Plan; or • the amount that would be paid for the Emergency Services under Medicare.
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SHL Reimbursement Schedule means the schedule showing the amount SHL will pay Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:
Sample 1Sample 2Sample 3
SHL Reimbursement Schedule means the schedule showing the amount SHL will pay for Eligible Medical Expenses, or the Recognized Amount when applicable, (EME) to Providers and will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on: • the amount most consistently paid to the Provider; or • the amount paid to other Providers with the same or similar qualifications; or • the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the geographic market, a gap methodology, or Eligible Medical Expenses, or the Recognized Amount when applicable, could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of: • the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or • 100% of the Eligible Medical Expenses, or the Recognized Amount when applicable, for Emergency Services provided by a Non-Plan Provider under your Plan; or • the amount that would be paid for the Emergency Services under Medicare.
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Examples of SHL Reimbursement Schedule in a sentence

  • In no event will SHL pay more than the maximum payment allowance established in the SHL Reimbursement Schedule.


More Definitions of SHL Reimbursement Schedule

SHL Reimbursement Schedule means the schedule showing the amount SHL will pay Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non- Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on: the amount most consistently paid to the Provider; or the amount paid to other Providers with the same or similar qualifications; or the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the geographic market, a gap methodology, or Eligible Medical Expense could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of: the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or 100% of the Eligible Medical Expense for Emergency Services provided by a Non- Plan Provider under your Plan; or the amount that would be paid for the Emergency Services under Medicare.
Sample 1
SHL Reimbursement Schedule means the schedule showing the amount SHL will pay Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:  the amount most consistently paid to the Provider; or  the amount paid to other Providers with the same or similar qualifications; or
Sample 1
SHL Reimbursement Schedule means the schedule showing the amount SHL will pay for Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:  the amount most consistently paid to the Provider; or  the amount paid to other Providers with the same or similar qualifications; or  the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the Agreement of Coverage geographic market, a gap methodology, or Eligible Medical Expense could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of:  the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or  100% of the Eligible Medical Expense for Emergency Services provided by a Non-Plan Provider under your Plan; or  the amount that would be paid for the Emergency Services under Medicare.
Sample 1

Related to SHL Reimbursement Schedule

  • Disbursement Schedule means the disbursement schedule as set out in an FAA;

  • Expense Reimbursement has the meaning set forth in Section 8.2(c).

  • Cost Reimbursement means a contract which provides for a fee other than a fee based on a percentage of cost and under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms.

  • Special Reimbursement Date means, the special payment date established in connection with a Reimbursement under Special Circumstances as described hereunder “Extraordinary Events and Special Circumstances – Reimbursement Under Special Circumstances and Payment”.

  • Cost-reimbursement contract means a contract under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms and the provisions of this code, and paid a fee, if any.

  • Payment Schedule ’ means a schedule which sets out—

  • Advance Reimbursement Amount has the meaning stated in Section 4.4(b) of the Servicing Supplement.

  • Advance Reimbursement Amounts As defined in Section 3.29 hereof.

  • Payment Date Advance Reimbursement has the meaning set forth in Section 8.03(a)(iii)(A) of the 20[•]-[•] Servicing Supplement.

  • Workout-Delayed Reimbursement Amounts With respect to any Mortgage Loan or Serviced Loan Combination, the amount of any Advance made with respect to such Mortgage Loan or Serviced Loan Combination on or before the date such Mortgage Loan or Serviced Loan Combination becomes (or, but for the making of three monthly payments under its modified terms, would then constitute) a Corrected Loan, together with (to the extent accrued and unpaid) interest on such Advances, to the extent that (i) such Advance is not reimbursed to the Person who made such Advance on or before the date, if any, on which such Mortgage Loan or Serviced Loan Combination becomes a Corrected Loan and (ii) the amount of such Advance becomes a future obligation of the Mortgagor to pay under the terms of modified Loan Documents. That any amount constitutes all or a portion of any Workout-Delayed Reimbursement Amount shall not in any manner limit the right of any Person hereunder to determine in the future that such amount instead constitutes a Nonrecoverable Advance.

  • Assigned Annual Special Tax means the Special Tax of that name described in Section D.

  • Insurance Cost Increase shall not, however, include any premium increases resulting from the nature of the occupancy of any other lessee of the Building. If the parties insert a dollar amount in Paragraph 1.9, such amount shall be considered the "BASE PREMIUM." If a dollar amount has not been inserted in Paragraph 1.9 and if the Building has been previously occupied during the twelve (12) month period immediately preceding the Commencement Date, the "Base Premium" shall be the annual premium applicable to such twelve (12) month period. If the Building was not fully occupied during such twelve (12) month period, the "Base Premium" shall be the lowest annual premium reasonably obtainable for the Required Insurance as of the Commencement Date, assuming the most nominal use possible of the Building. In no event, however, shall Lessee be responsible for any portion of the premium cost attributable to liability insurance coverage in excess of $1,000,000 procured under Paragraph 8.2(b).

  • Equipment Schedule means (a) each Equipment Schedule attached to the applicable Requisition and (b) each Equipment Schedule attached to the applicable Lease Supplement.

  • Shift Schedule means a written statement setting forth the days and hours upon which the employees are required to work.

  • Program Expenses means all UHC’s expenses of administering the Program under the Indenture and the Act and shall include without limiting the generality of the foregoing; salaries, supplies, utilities, labor, materials, office rent, maintenance, furnishings, equipment, machinery and apparatus, including information processing equipment; software, insurance premiums, credit enhancement fees, legal, accounting, management, consulting and banking services and expenses; Fiduciary Expenses; remarketing fees; Costs of Issuance not paid from proceeds of Bonds; and payments to pension, retirement, health and hospitalization funds; and any other expenses required or permitted to be paid by UHC.

  • Servicing Advance Reimbursement Amounts As defined in Section 3.22.

  • Repayment Schedule means the schedule of Repayment Instalments in the agreed inserted into this Agreement in accordance with Clause 6.1 (Repayment) as Schedule 1 (Repayment Schedule), and as replaced from time to time pursuant to Clause 6.4;

  • Insurance Costs means the sums described in paragraph 1.1 of Part 5 of the Schedule;

  • Additional Fees means those prices for the Additional Goods/Services and additional costs and levies required from time to time and notified to you in advance, to provide adequately for the education and related activities and services provided to your Child, including the costs of extra-curricular activities or special educational needs;

  • Additional Payment is as defined in Section 6 of the Agreement.

  • Medical Reimbursement Programs means a collective reference to the Medicare, Medicaid and TRICARE programs and any other health care program operated by or financed in whole or in part by any foreign or domestic federal, state or local government.