Coverage Gap definition

Coverage Gap means the stage of the benefit between the initial coverage limit and the catastrophic coverage threshold, as described in the Medicare Part D prescription drug program administered by the United States federal government.

Coverage Gap means the phase in prescription drug coverage that occurs between the initial coverage limit (as defined in 1860D-2(b)(3) of the Act) and the out-of-pocket threshold (as defined in section 1860D-2(b)(4)(B) of the Act). For purposes of applying the initial coverage limit, Part D sponsors shall apply their plan specific initial coverage limit under basic alternative, actuarially equivalent, or enhanced alternative Part D benefit designs.

Coverage Gap means the out-of-pocket expenses for medications between the point where an eligible person exceeds the Medicare Part D coverage limit under § 1860D-2(b)(3) (42 U.S.C. § 1395w-114a) of the Patient Protection and Affordable Care Act and below the catastrophic amount specified in § 1860D2(b)(4)(B) of the Patient Protection and Affordable Care Act for the year.

Examples of Coverage Gap in a sentence

• Remember you are responsible for all of the costs associated with vaccines (including their administration) during the Deductible and Coverage Gap Stage of your benefit.Situation 1: You buy the Part D vaccine at the pharmacy and you get your vaccine at the network pharmacy.

• Remember you are responsible for all of the costs associated with vaccines (including their administration) during the Coverage Gap Stage of your benefit.Situation 1: You buy the Part D vaccine at the pharmacy and you get your vaccine at the network pharmacy.

• Medicare Coverage Gap Discount ProgramThe Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D members who have reached the coverage gap and are not receiving “Extra Help.” For brand name drugs, the 70% discount provided by manufacturers excludes any dispensing fee for costs in the gap.

• Also, the dispensing fee is included as part of the cost of the drug.The Medicare Coverage Gap Discount Program is available nationwide.

• If you get “Extra Help,” the Medicare Coverage Gap Discount Program does not apply to you.

• The Medicare Coverage Gap Discount Program is available nationwide.

• Excess / ExcessesThe amount(s) shown in Your policy or Schedule, for which You are responsible and which We will deduct from each and every claim.Index-LinkingWhenever a Sum Insured or Declared Value is declared to be subject to Index-Linking it is adjusted at monthly intervals as follows:1.

• Please go to Chapter 6, Section 6 for more information about your coverage during the Coverage Gap Stage.

• If you have any questions about the availability of discounts for the drugs you are taking or about the Medicare Coverage Gap Discount Program in general, please contact Member Services (phone numbers are printed on the back cover of this booklet).

• Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage.

More Definitions of Coverage Gap

Coverage Gap means the gap phase in prescription drug coverage that occurs between the initial coverage limit (as defined in 1860D-2(b)(3)) and the out-of-pocket threshold (as defined in section 1860D-2(b)(4)(B)). For purposes of applying the initial coverage limit, Part D sponsors shall apply their plan specific initial coverage limit under basic alternative or actuarially equivalent Part D benefit designs.

Coverage Gap means a geographic area where a telecommunication carrier has a significant gap in service coverage.

Coverage Gap means the need for additional capacity because of inadequate present capacity or service, dead spots, and inability to place a call.

Coverage Gap has the meaning set forth in 42 CFR §423.100.

Coverage Gap means the out-of-pocket expenses for medications between the point where an eligible person exceeds the initial coverage limit ($2,840 in retail drug costs for covered drugs in 2011) under section 1860D-2(b)(3) (42 U.S.C. 1395w-114a) of the Patient Protection and Affordable Care Act and below the annual out of pocket threshold specified in section 1860D2(b)(4)(B) for the year ($4,550 in 2011). These annual out-of-pocket expenses include annual deductibles, co-payments, and coinsurance amounts.