PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member as set forth in SECTION SB - SCHEDULE OF BENEFITS of this Agreement, and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider, or Dentist, Telemedicine Provider, and Vision Provider, each of whom is a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider, or Dentist, Telemedicine Provider or Vision Provider, each of whom is a Network Provider, will accept the Plan Allowance, plus any Member liability, as payment-in-full for Covered Services. In the case of an In-Area Out-of-Network Provider, the Plan Allowance shall be based on an adjusted contractual allowance for like services rendered by a Network Provider in the same geographic region. The Member will be responsible for any difference between the Provider’s billed charges and the Plan’s payment. In the case of an Out-of-Area Provider, whether or not such Out-of-Area Provider has an agreement with the local licensee of the Blue Cross Blue Shield Association, the Plan Allowance shall be determined, for other than pediatric dental and vision care and telemedicine Covered Services, based on prices received from the local licensee in accordance with the Plan’s participation in the INTER-PLAN ARRANGEMENTS as set forth in SECTION GP - GENERAL PROVISIONS of this Agreement. 112. PRECERTIFICATION (CERTIFICATION) - a process whereby the Medical Necessity and Appropriateness of Inpatient admissions, Services or place of Services is determined by the Plan prior to, or after, an admission or the performance of a procedure or Service.
PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member as set forth in SECTION SB - SCHEDULE OF BENEFITS of this Agreement, and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider or Dentist, Telemedicine Provider, and Vision Provider, each of whom is a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider or Dentist, Telemedicine Provider or Vision Provider, each of whom is a Network Provider, will accept the Plan Allowance, plus any Member liability, as payment- in-full for Covered Services. In the case of an In-Area Out-of-Network Provider the Plan Allowance shall be based on an adjusted contractual allowance for like services rendered by a Network Provider in the same geographic region. The Member will be responsible for any difference between the Provider’s billed charges and the Plan’s payment. In the case of a Provider located Out-of-Area, whether or not such Provider has an agreement with the local licensee of the Blue Cross Blue Shield Association, the Plan Allowance shall be determined, for other than pediatric dental and vision care and telemedicine Covered Services, based on prices received from the local licensee in accordance with the Plan’s participation in the INTER-PLAN ARRANGEMENTS as set forth in SECTION GP - GENERAL PROVISIONS of this Agreement.
PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member as set forth in SECTION SB - SCHEDULE OF BENEFITS of this Agreement, and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider or Dentist, Telemedicine Provider and Vision Provider, each of whom is a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider or Dentist, Telemedicine Provider or Vision Provider, each of whom is a Network Provider, will accept the Plan Allowance, plus any Member liability, as payment in full for Covered Services. In the case of an Out-of-Area Provider, the Plan Allowance shall be determined, for other than pediatric dental and vision care and telemedicine Covered Services, based on prices received from the local licensee of the Blue Cross Blue Shield Association in accordance with the Plan’s participation in the INTER-PLAN ARRANGEMENTS as set forth in SECTION GP - GENERAL PROVISIONS of this Agreement. 110. PLAN SERVICE AREA - the geographic area consisting of the following counties in western Pennsylvania: Allegheny Centre (Part) Forest Xxxxxx Xxxxxxxxx Clarion Xxxxxx Xxxxxx Xxxxxx Clearfield Huntingdon Somerset Bedford Xxxxxxxx Indiana Venango Xxxxx Elk Xxxxxxxxx Xxxxxx Xxxxxx Erie Xxxxxxxx Xxxxxxxxxx Cambria Xxxxxxx XxXxxx Xxxxxxxxxxxx Xxxxxxx 111. PRECERTIFICATION (CERTIFICATION) - a process whereby the Medical Necessity and Appropriateness of Inpatient admissions, Services or place of Services is determined by the Plan prior to, or after, an admission or the performance of a procedure or Service. 112. PREFERRED VALUE - the level of Network benefits providing for the lowest level of Member cost-sharing for Covered Services.
PLAN ALLOWANCE. Provided that Subtenant is in full compliance with this Sublease, Sublandlord agrees to contribute $0.12 per rentable square foot of the Subleased Premises (“Plan Allowance”) toward the cost of preparing Subtenant’s Plans based on the Approved Plans. Within thirty (30) days following Subtenant’s written request to Sublandlord, Sublandlord shall pay such sum to Subtenant, provided such written request may not be submitted until the Subtenant has delivered to Sublandlord all mechanics’ lien releases or other lien releases on account of Subtenant’s Work, which are notarized, unconditional and in recordable form or in such form as Sublandlord shall have approved. To the extent the Plan Allowance exceeds the costs of preparing Subtenant’s Plans, the excess amount will be applied toward the Improvement Allowance described in Section 5.4 below.
PLAN ALLOWANCE. The Benefit payment amount is based on the Plan Allowance on the date the Covered Drug is dispensed or the date the service is rendered.
PLAN ALLOWANCE. Effective October the Company will pro- vide on weekly paycheques, a payment of per week to in lieu of Company contributions formerly paid into the pension plan. This is based upon conditions expressed in letter of understanding attached. This allowance will be considered as earnings for the purpose of vacation pay calculation in Article Effective January the Company will cease pay- ing employees per week on weekly paycheques, and make a lump sum payment of on December of each year. For those employees who do not work weeks during the calendar year, the amount will be pro-rated accordingly. Welfare Plan
PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider will accept the Plan Allowance, plus any Member liability, as payment in full for Covered Services. In the case of a Network Dental Provider, the Plan Allowance is expressed in terms of the Maximum Allowable Charge.
PLAN ALLOWANCE a. Employees will be responsible for choosing their own voice or data plan as well as their carrier. Employees may also, at his or her own expense, add extra services or equipment features, as desired.
