Out-of-Network Covered Services Sample Clauses

Out-of-Network Covered Services. When a member incurs $2,400 in coinsurance expense for out-of-network covered services furnished to the member in one (1) Benefit Period, the benefits payable for claims received by the Plan for that member during the remainder of the Benefit Period will increase to one hundred percent (100%) of the Provider’s Reasonable Charge. The dollar amount specified shall not include any amounts paid for deductibles or amounts in excess of the Provider’s Reasonable Charge.
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Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 in Deductible, Copayment and Coinsurance expenses for Out-of-Network Covered Services furnished to Members in one (1) Benefit Period, the benefits payable for claims received by the Plan thereafter for all Members under that same Family Coverage during the remainder of the Benefit Period will increase to one hundred percent (100%) of the Plan Allowance. In the case of Family Coverage, no individual Member may contribute Deductible, Copayment and Coinsurance expenses greater than their Individual Out-of-Pocket Maximum. However, as each Member reaches their Individual Out-of-Pocket Maximum, the benefits payable for that Member will increase to one hundred percent (100%) of the Plan Allowance for the remainder of the Benefit Period, whether or not the Family Out-of-Pocket Maximum has been met. The dollar amount specified shall not include amounts in excess of the Plan Allowance.
Sample 1See All (7)
Out-of-Network Covered Services. When members under the same family coverage have incurred $4,000 in coinsurance expense for out-of-network covered services furnished to the members in one (1) Benefit Period, the benefits payable for claims received by the Plan thereafter for all members under that same family coverage during the remainder of the Benefit Period will increase to one hundred percent (100%) of the Provider’s Reasonable Charge. In the case of family coverage, benefits for any individual will not increase to one hundred percent (100%) of the Provider’s Reasonable Charge until the entire Family Out-of-Pocket Limit has been satisfied. The dollar amount specified shall not include any amounts paid for deductibles or amounts in excess of the Provider’s Reasonable Charge.
Sample 1See All (5)

Related to Out-of-Network Covered Services

  • Out-of-Network Services We Cover the services of Non-Participating Providers. See the Schedule of Benefits section of this Contract for the Non-Participating Provider services that are Covered. In any case where benefits are limited to a certain number of days or visits, such limits apply in the aggregate to in-network and out-of-network services.

  • Out of Network Covered for Medical Base Plan with $600 deductible and 70% coinsurance up to the annual out-of-pocket maximum. Pre-arranged services while outside the area are covered as if in-network.

  • Covered Services Services to be performed by Contractor under this Agreement may involve the performance of trade work covered by the provisions of Section 6.22(e) [Prevailing Wages] of the Administrative Code or Section 21C [Miscellaneous Prevailing Wage Requirements] (collectively, “Covered Services”). The provisions of Section 6.22(e) and 21C of the Administrative Code are incorporated as provisions of this Agreement as if fully set forth herein and will apply to any Covered Services performed by Contractor and its subcontractors.

  • Verizon’s Provision of Network Elements Subject to the conditions set forth in Section 1, in accordance with, but only to the extent required by, Applicable Law, Verizon shall provide PCS access to the following:

  • Services Rendered/Scope of Work The Contractor shall, in a satisfactory and proper manner as determined by the Authority, render the services described in Exhibit A, which is attached and made a part of this Agreement.

  • Support Services HP’s support services will be described in the applicable Supporting Material, which will cover the description of HP’s offering, eligibility requirements, service limitations and Customer responsibilities, as well as the Customer systems supported.

  • Hosting Services 13.1 If Supplier or its subcontractor, affiliate or any other person or entity providing products or services under the Contract Hosts Customer Data in connection with an Acquisition, the provisions of Appendix 1, attached hereto and incorporated herein, apply to such Acquisition.

  • Technical Support Services 2.1 The technical support services (the "Services"): Party A agrees to provide to Party B the relevant services requested by Party B, which are specified in Exhibit 1 attached hereto ("Exhibit 1").

  • Conversion of Wholesale Services to Network Elements or Network Elements to Wholesale Services Upon request, BellSouth shall convert a wholesale service, or group of wholesale services, to the equivalent Network Element or Combination that is available to Global Dialtone pursuant to Section 251 of the Act and under this Agreement or convert a Network Element or Combination that is available to Global Dialtone pursuant to Section 251 of the Act and under this Agreement to an equivalent wholesale service or group of wholesale services offered by BellSouth (collectively “Conversion”). BellSouth shall charge the applicable nonrecurring switch-as-is rates for Conversions to specific Network Elements or Combinations found in Exhibit A. BellSouth shall also charge the same nonrecurring switch-as-is rates when converting from Network Elements or Combinations. Any rate change resulting from the Conversion will be effective as of the next billing cycle following BellSouth’s receipt of a complete and accurate Conversion request from Global Dialtone. A Conversion shall be considered termination for purposes of any volume and/or term commitments and/or grandfathered status between Global Dialtone and BellSouth. Any change from a wholesale service/group of wholesale services to a Network Element/Combination, or from a Network Element/Combination to a wholesale service/group of wholesale services, that requires a physical rearrangement will not be considered to be a Conversion for purposes of this Agreement. BellSouth will not require physical rearrangements if the Conversion can be completed through record changes only. Orders for Conversions will be handled in accordance with the guidelines set forth in the Ordering Guidelines and Processes and CLEC Information Packages as referenced in Sections 1.13.1 and 1.13.2 below.

  • Maintenance and Support Services As long as you are not using the Help Desk as a substitute for our training services on the Tyler Software, and you timely pay your maintenance and support fees, we will, consistent with our then-current Support Call Process:

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