Calendar Year Deductible Sample Clauses

Calendar Year Deductible. This amount, when applicable, must be satisfied each Calendar Year before AvMed’s payment toward Covered Services will begin. Only those expenses for Covered Services submitted on Claims to AvMed will be credited toward the Calendar Year Deductible. Certain Covered Services may not be subject to the Calendar Year Deductible, as shown in your Schedule of Benefits.
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Calendar Year Deductible. The Calendar Year Deductible is the amount of expenses you must incur in each 12-month period (January 1 through December 31) for Covered Services and supplies before this plan provides certain benefits. Copays do not count toward the Calendar Year Deductible. Covered Services received from In-Network Providers, except Prescription Drug services, that require a Copay do not apply to your Calendar Year Deductible. All Covered Services received from In-Network Providers that do not require a Copay will apply to your Calendar Year Deductible. The amount applied toward your Calendar Year Deductible for any Covered Service or supply will not exceed the Allowed Amount (please see the Definitions section in this Agreement). This plan has different Deductibles for services and supplies received from In-Network Providers, and for services and supplies received from Out-of-Network Providers. The Deductible for services from Out-of-Network Providers is called the Out-of- Network Deductible. Individual Deductible The Individual Deductible is the fixed amount each Member must incur and satisfy before certain benefits of this plan are provided.
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Calendar Year Deductible a. Waived for routine examinations as prescribed under Preventive Care Services.
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Calendar Year Deductible. For Plans with a Calendar Year Deductible, the De- ductible applies to all Covered Services and supplies furnished by Participating and Non-Participating Den- tists, except as specified in the Summary of Benefits which is attached to and made a part of this EOC. It is the amount which you must pay out of pocket for charges that would otherwise be payable for Dental Care Services and supplies. Charges in excess of the Allowable Amount do not apply toward the Deductible. This per Member Deductible applies separately to each covered Member each Calendar Year, except that no more than the Family Deductible amount is required of a Family in a Calendar Year. Note: The Deductible also applies to a newborn child or a child placed for adop- tion, who is covered for the first 31 days, even if appli- cation is not made to add the child as a Dependent on the Plan. The Calendar Year per Member and Family Deductible amounts, if applicable, are listed in the Summary of Benefits which is attached to and made a part of this EOC. PRECERTIFICATION OF DENTAL BENEFITS PROGRAM Before any course of treatment expected to cost more than $250 is started, you should obtain precertification of Benefits. Note: If your Plan provides special Implant Benefits, you must obtain precertification/prior autho- rization for these Benefits before services are provided or Benefits will be denied. Your Dentist should submit the recommended treat- ment plan and fees together with appropriate diagnos- tic x-rays to a Dental Plan Administrator. A Dental Plan Administrator will review the dental treatment plan to determine the Benefits payable under the Plan. The Benefit determination for the proposed treatment plan will then be promptly returned to the Dentist. When the treatment is completed, your claim form should be sub- mitted to a Dental Plan Administrator for payment de- termination. A Dental Plan Administrator will notify you of its determination within 30 days after receipt of the claim. The dental Plan provides Benefits for Covered Services at the most cost effective level of care that is consistent with professionally recognized standards of care. If there are two or more professionally recognized proce- dures for treatment of a dental condition, the Plan will in most cases provide Benefits based on the most cost effective procedure. The Benefits provided under the Plan are based on these considerations but you and your Dentist make the final decision regarding treatment. If your Plan prov...
Sample 1
Calendar Year Deductible. Prudent Buyer Plan Providers & Related Health Providers Non-Prudent Buyer Plan Providers Individual Family $300 $900 $ 600 $ 1,800 Type of Services Description of Services What You Pay Prudent Buyer Plan Providers Non-Prudent Buyer Plan Providers* Hospital Services Inpatient Semi-private room/board, special care units and all medically necessary ancillary services and supplies 10% 10%* Hospital Services Outpatient Surgical room fee, radiation and chemotherapy treatment and renal dialysis 10% 10%* Non-emergency use of the emergency room 50% 50%* Physician Care Office visits $20 co-pay (No deductible) 10%* Note: This co-pay applies to the charge for the Physician visit only. Home and hospital visits obstetrical care surgery 10% 10%* Allergy testing, serum injections and medication dispensed or administered by a Physician 10% 10%* Preventive Care No charge No charge* Services (No deductible) (No deductible) *The Member's payment for Non-Prudent Buyer Plan Provider services is based on a strictly limited schedule of allowances, and Members must pay charges in excess of those scheduled amounts. Please refer to the sections entitled DETERMINATION OF THE MAXIMUM ALLOWED AMOUNT beginning on page 16 and SCHEDULES FOR NON-PRUDENT BUYER PLAN PROVIDERS beginning on page 121 for complete benefit information.
Sample 1
Calendar Year Deductible. The Calendar Year Deductible is the amount of expense you must incur in each 12‐month period (January through December) for Covered Services and supplies before this plan provides certain benefits. Covered Services, except Prescription Drug services, received from In‐Network Providers requiring a Copay do not apply to your Calendar Year Deductible. All Covered Services received from In‐Network Providers that do not require a Copay will apply to your Calendar Year Deductible. The amount applied toward your Calendar Year Deductible for any Covered Service or supply will not exceed the Allowed Amount (please see the Definitions section in this Agreement). Copays do not count toward the Calendar Year Deductible. This plan has different Deductibles for services received from In‐ Network Providers and for services received from Out‐of‐Network Providers. The Deductible for services from Out‐ of‐Network Providers is called the Out‐of‐Network Deductible.
Sample 1
Calendar Year Deductible. For Covered Retired Employees retiring on or after April 1, 1996, the calendar year deductible shall be as follows:
Sample 1
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Related to Calendar Year Deductible

  • Calendar Year Calendar Year" for the purposes of this Agreement shall mean the twelve (12) month period from January 1st to December 31st, inclusive.

  • Limitation Year The Limitation Year is: (Choose (c) or (d)) [ x ] (c) The Plan Year. [ ] (d) The 12 consecutive month period ending every _____.

  • Adjustment of Minimum Quarterly Distribution and Target Distribution Levels (a) The Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution, Third Target Distribution, Common Unit Arrearages and Cumulative Common Unit Arrearages shall be proportionately adjusted in the event of any distribution, combination or subdivision (whether effected by a distribution payable in Units or otherwise) of Units or other Partnership Securities in accordance with Section 5.10. In the event of a distribution of Available Cash that is deemed to be from Capital Surplus, the then applicable Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, shall be adjusted proportionately downward to equal the product obtained by multiplying the otherwise applicable Minimum Quarterly Distribution, First Target Distribution, Second Target Distribution and Third Target Distribution, as the case may be, by a fraction of which the numerator is the Unrecovered Capital of the Common Units immediately after giving effect to such distribution and of which the denominator is the Unrecovered Capital of the Common Units immediately prior to giving effect to such distribution.

  • Minimum Revenue Borrower and its Subsidiaries shall have annual Revenue from sales of the Product (for each respective calendar year, the “Minimum Required Revenue”):

  • Elective Deferrals An Employee will be eligible to become a Contributing Participant in the Plan (and thus be eligible to make Elective Deferrals) and receive Matching Contributions (including Qualified Matching Contributions, if applicable) after completing 1 (enter 0, 1 or any fraction less than 1) Years of Eligibility Service.

  • Exclusions from Operating Expenses Notwithstanding anything to the contrary contained herein, in no event shall Operating Expenses include any of the following: (1) costs for which Landlord is reimbursed, receives a credit or is otherwise compensated (other than tenant reimbursements for Operating Expenses); (2) rent or other amounts payable under any ground lease or master lease, or interest, amortization or other repayment of indebtedness or costs, fees, points or other expenses in connection with any financing or refinancing of all or any part of the Real Property; (3) costs of correcting defects in the initial design or construction of the Building or any expansion thereof or any expenses resulting from inferior or deficient workmanship; (4) costs of repair or restoration required due to casualty damage or condemnation (except for commercially reasonable deductibles); (5) non-refundable reserves for anticipated or unanticipated future expenses; (6) interest or penalties incurred as a result of Landlord’s failure to pay any bill as it shall become due; (7) costs resulting from the gross negligence or willful misconduct of Landlord, its employees, and/or agents; (8) leasing commissions, attorneys’ fees, costs and disbursements, and other expenses (including, without limitation, advertising and marketing costs) incurred in connection with leasing, renovating, or improving space for tenants or other occupants or prospective tenants or occupants of the Building, or costs (including, without limitation, permit, license, and inspection fees) incurred in renovating or otherwise improving or decorating, painting or redecorating space for tenants or other occupants or vacant space; (9) costs of any services sold to tenants or other occupants for which Landlord is entitled to be reimbursed by such tenants or other occupants as an additional charge or rental over and above the basic rent and escalations payable under the lease with such tenant or other occupant; (10) allowances for depreciation of improvements in the Common Areas; and (11) so called “capital items” or “capital expenditures” which, pursuant to generally accepted accounting principles, are not fully chargeable to current expenses in the year the expenditure is incurred, except to the extent such capital expenditures are amortized over their useful life (with commercially reasonable interest) in accordance with generally accepted accounting principles and only with respect to those that (A) are intended to effect economies in the operation or maintenance of the Real Property, or any portion thereof, or (B) are installed with a reasonable and good faith expectation by Landlord that the same will reduce current or future Operating Expenses, or (C) are intended to enhance the safety or security of the Real Property or its occupants, or (D) are required to comply with present or anticipated conservation programs, or (E) are otherwise includable in Operating Expenses pursuant to the application of sound real estate management principles (including but not limited to, parking lot repair and resurfacing).

  • CONTRACT YEAR A twelve (12) month period during the term of the Agreement commencing on the Effective Date and each anniversary thereof.

  • Distribution of Excess Contributions If the Advisory Committee determines the Plan fails to satisfy the ADP test for a Plan Year, it must distribute the excess contributions, as adjusted for allocable income, during the next Plan Year. However, the Employer will incur an excise tax equal to 10% of the amount of excess contributions for a Plan Year not distributed to the appropriate Highly Compensated Employees during the first 2 1/2 months of that next Plan Year. The excess contributions are the amount of deferral contributions made by the Highly Compensated Employees which causes the Plan to fail to satisfy the ADP test. The Advisory Committee will distribute to each Highly Compensated Employee his respective share of the excess contributions. The Advisory Committee will determine the respective shares of excess contributions by starting with the Highly Compensated Employee(s) who has the greatest ADP, reducing his ADP (but not below the next highest ADP), then, if necessary, reducing the ADP of the Highly Compensated Employee(s) at the next highest ADP level (including the ADP of the Highly Compensated Employee(s) whose ADP the Advisory Committee already has reduced), and continuing in this manner until the average ADP for the Highly Compensated Group satisfies the ADP test. If the Highly Compensated Employee is part of an aggregated family group, the Advisory Committee, in accordance with the applicable Treasury regulations, will determine each aggregated family member's allocable share of the excess contributions assigned to the family unit.

  • Minimum Sales 4.1 The minimum volume of sales of the Products that CSR commits to use its best efforts to achieve in the Territory on an annual basis in the first Agreement Year is 60,000 gallons (avg. 5,000 gallons per month). RCAI will review the annual volumes of sales of the Products prior to the beginning of any successive term during which this Agreement may continue and RCAI may change and adjust such minimums as it, in its sole judgment, sees fit.

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