Network Benefits. Benefits - Benefits apply when you choose to obtain Covered Dental Care Services from a Network Dental Provider. Network Benefits are determined based on the contracted fee for each Covered Dental Service. In no event, will you be required to pay a Network Dental Provider an amount for a Covered Dental Service that is greater than the contracted fee. In order for Covered Dental Care Services to be paid, you must obtain all Covered Dental Care Services directly from or through a Network Dental Provider. You must always check the participation status of a provider prior to seeking services. From time to time, the participation status of a provider may change. You can check the participation status by contacting us and/or the provider. We can provide help in referring you to a Network Dental Provider. We will make available to you a Directory of Network Dental Providers. You can also call us at the number stated on your identification (ID) card to determine which providers participate in the Network. Benefits are not available for Dental Care Services that are not provided by a Network Dental Provider. Referral to Out-of-Network Specialist You may request a referral to an out-of-Network Dental Provider who is a non-Physician Specialist if a Covered Person is diagnosed with a condition or disease that requires specialized Dental Services, and: • There is no Network Dental Provider with the professional training and expertise to treat or provide Dental Services for the condition or disease; or • We cannot provide reasonable access to a Network Dental Provider with the professional training and expertise to treat or provide Dental Services for the condition or disease without unreasonable delay or travel. The Covered Person or Dental Provider requesting the referral must contact us to obtain our approval of the referral. The term "non-Physician Specialist" means a health care provider who: • Is not a Physician; • Is licensed or certified under the Maryland Health Occupations Article; and • Is certified or trained to treat or provide Dental Services for a specified condition or disease in a manner that is within the scope of the license or certification of the health care provider.
Network Benefits. The Network makes benefits available with your Account that are not part of this Agreement and are subject to change or cancellation. Details about Network benefits can be found in Apple Wallet or by reviewing xxxx.xxxxx.xxx.
Network Benefits. Benefits for Covered Services received from Network Providers (Providers contracted in the Preferred Care Network or another Blue Plan’s network).
Network Benefits. Benefits - Benefits apply when you choose to obtain Covered Dental Care Services from a Network Dental Provider. Network Benefits are determined based on the contracted fee for each Covered Dental Service. In no event, will you be required to pay a Network Dental Provider an amount for a Covered Dental Service that is greater than the contracted fee. In order for Covered Dental Care Services to be paid, you must obtain all Covered Dental Care Services directly from or through a Network Dental Provider. You must always check the participation status of a provider prior to seeking services. From time to time, the participation status of a provider may change. You can check the participation status by contacting us and/or the provider. We can provide help in referring you to a Network Dental Provider. We will make available to you a Directory of Network Dental Providers. You can also call us at the number stated on your identification (ID) card to determine which providers participate in the Network. Benefits are not available for Dental Care Services that are not provided by a Network Dental Provider.
Network Benefits. Members will have coverage for a Routine Eye Examination according to the terms of Schedule of Vision Benefits and as described below. In addition to the Routine Eye Examination, Members may have coverage for materials or laser vision correction services, as described below. The Schedule of Vision Benefits will state if the Member has coverage for materials and laser vision correction services. Routine Eye Health Examination After Member’s payment of any applicable copayment stated on the Schedule of Vision Benefits, the Company will cover one Routine Eye Health Examination. Covered Routine Eye Health Examinations will include dilation of eye pupils when professionally indicated. Routine Eye Health Examinations will be limited to the frequency stated in the Schedule of Vision Benefits. Materials Prescription Spectacle Lens for Each of the Member’s Eyes After Member’s payment of any applicable copayment, the Company will cover one prescription Spectacle Lens for each of the Member’s eyes, as stated in the Schedule of Vision Benefits. The type of lens materials covered will be explained in the Schedule of Vision Benefits. Prescription Spectacle Lens coverage will be limited to the frequency stated in the Schedule of Vision Benefits. The Member may be able to enhance the Spectacle Lenses covered above at discounted prices. The Schedule of Vision Benefits may include discounted prices for some special types of lens materials and other enhancements. Any available enhancement options are not to be considered coverage under this Benefit Plan. Eyeglass Frames After Member’s payment of any applicable copayment stated in the Schedule of Vision Benefits, the Company will cover one eyeglass frame, up to any maximum allowance specified in the Schedule of Vision Benefits. Certain private practice Participating Providers carry the Xxxxx Vision Frame Collection, which the Member can get with little or no out-of-pocket costs, as stated in the Schedule of Vision Benefits. To know which Providers carry the Frame Collection, please visit our website at xxx.xxxxxx.xxx to search for the Xxxxx Vision Providers near You. All Eyeglass Frames coverage will be limited to the frequency stated in the Schedule of Vision Benefits. Prescription Contact Lenses After Member’s payment of any applicable copayment stated in the Schedule of Vision Benefits, the Company will cover one prescription Contact Lens for each of the Member’s eyes, up to the maximum allowance indicated in the Schedule ...
Network Benefits. Members will have coverage for a Routine Eye Examination according to the terms of Schedule of Vision Benefits and as described below. In addition to the Routine Eye Examination, Members may have coverage for materials or laser vision correction services, as described below. The Schedule of Vision Benefits will state if the Member has coverage for materials and laser vision correction services.
Network Benefits. The Network makes benefits available with your Account that are not part of this Agreement and are subject to change or cancellation. Details about Network benefits can be found in the Wallet app. Daily Cash Program This section explains how you can earn and receive Daily Cash in connection with your Account. HOW YOU EARN DAILY CASH Earning Daily Cash You will earn Daily Cash on every Purchase Transaction posted to your Account as described below: Transaction type Daily Cash percentage Goods or services purchased directly from Apple. These include purchases from Apple retail stores, the Apple online store, iTunes, Apple Music and other Apple-owned properties. App Store purchases (including In-App Purchases*). 3% of the transaction amount Apple Pay Purchase Transactions 2% of the transaction amount All other Purchase Transactions 1% of the transaction amount *"In-App Purchases" means content, services or functionality that you can buy for use in apps on your Apple devices, including premium content, digital goods and subscriptions. If any Purchase Transaction is covered by more than one Transaction type, the highest Daily Cash percentage will apply. For example, a Purchase Transaction at an Apple-owned retail store using Apple Pay would earn 3% Daily Cash, but would not also earn the 2% Daily Cash for Apple Pay transactions. You may earn Daily Cash as long as your Account remains open and in good standing, except as otherwise provided in this Agreement. Any accrued but unredeemed Daily Cash will not earn or accrue any interest, and we do not consider this Daily Cash when calculating the interest or Minimum Payment Due on your Account. HOW YOUR DAILY CASH WILL BE CALCULATED Daily Cash will be calculated based on the amount of each Purchase Transaction posted to your Account, multiplied by the above-listed percentage corresponding to the Transaction type. Daily Cash will be rounded to the nearest cent but will not be less than one cent. EXCEPTIONS You will not earn 3% Daily Cash for purchases of Apple goods and services that are sold through third party retail or online stores, including any Apple authorized resellers, or if you make your payment through a third party wallet. You will not earn Daily Cash for transactions that are not permissible under this Agreement or on purchases made for purposes of resale.
Network Benefits a. Inpatient hospital semi-private room and board, services and supplies will be reimbursed at 80% of allowable expenses after a $200 deductible per admission. Doctor's in-hospital consultations, radiologist's fees, anesthesiologist's fees, surgeon's fees and assistant surgeon's fees (in a hospital where an intern resident or a house staff member is not available) will be covered in full.
Network Benefits. In order to be eligible to enroll and participate in this Plan you must work for an employer Group that is headquartered in the State of New Mexico (our Service Area). Your Dependents may be eligible to enroll if they meet all of the terms and conditions for such Coverage as described in the Eligibility, Enrollment and Effective Dates, Termination and Continuation of Coverage Section. When you or your Covered Dependents receive care from Practitioners and Providers in our network (In-network Practitioners/Providers), the In-network benefit level will apply to the cost of the Health Care Services. You will be responsible for your Cost Sharing amounts (Copayments, Deductibles or Coinsurance) at the time of service. As shown in your Summary of Benefits and Coverage, your benefit levels are highest and your Out-of- pocket Cost Sharing amounts are lowest when you use our In-network Practitioner/Providers. Your In-network Practitioner/Provider will bill us directly for the cost of services. You will generally not have claims to file or papers to fill out in order to be reimbursed for medical services obtained from In-network Practitioners and Providers. In-network Practitioners and Providers cannot bill you for any additional costs over and above your Cost Sharing amounts. Hospital Inpatient Admission and some other Health Care Services require our review and Prior Authorization before the services are provided. If you seek care from an In-network Practitioner/Provider, your In-network Practitioner/Provider will notify us and handle all aspects of your care. Please refer to the Prior Authorization Section for complete details on Prior Authorization. Provider Directory You will find our In-network Practitioners/Providers close to where you live and work across the State. Our Provider Directory lists the In-network Practitioners, as well as In-network Hospitals, pharmacies, outpatient facilities and other health care Providers. The Provider Directory is available on our website at xxxxx://xxx.xxx.xxx/Pages/find-a- doctor.aspx. If you need additional information about a Provider, you may call our Presbyterian Customer Service Center Monday through Friday from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call the TTY 711. The Provider Directory is subject to change and you should always verify the Practitioner/Provider’s network status by visiting our website at xxxxx://xxx.xxx.xxx/Pages/find-a-doctor.aspx. Out-of-network Benefits...
Network Benefits. The Empire Plan shall include medical/surgical coverage through use of participating providers who will accept the Plan's schedule of allowances as payment in full for covered services. Except as noted below, benefits shall be paid directly to the provider at 100 percent of the Plan's schedule not subject to deductible or coinsurance.
