Examples of Maximum Reimbursement Allowance in a sentence
Until The Plan has determined the Maximum Reimbursement Allowance and notified Group as to the amount due from the Blue Preferred PPO Member, if any, under the Blue Preferred PPO Member's Benefit Agreement, Group shall not bill or attempt to collect from the Blue Preferred PPO Member any coinsurance amounts.
This paragraph shall supersede any provision contained in the Blue Choice PPO Addendum, if applicable, to accept the Blue Choice PPO Maximum Reimbursement Allowance for any Member whose designated network is one in which Group does not participate.
Except as set forth below, the Maximum Reimbursement Allowance for Covered Services rendered to Blue Preferred PPO Members shall be as set forth in the Agreement.
In the event that Group has not separately contracted with The Plan for its other networks, including but not limited to BlueLincs HMO or Blue Advantage PPO, the terms of this Blue Preferred PPO Addendum, including the Maximum Reimbursement Allowance described herein, shall be applicable to any Covered Services rendered to a Member whose designated network is one in which Group does not participate.
Group agrees to hold such Member harmless from any sums in excess of the Blue Preferred PPO Maximum Reimbursement Allowance.
Group agrees to accept as payment in full for Covered Services rendered to Blue Preferred PPO Members, the lesser of Group's Usual Charge or The Plan's Maximum Reimbursement Allowance set forth in Article III and hold Blue Preferred PPO Members harmless from any sums in excess of this Maximum Reimbursement Allowance.
The total amount collected from The Plan, or administered accounts, and the Blue Preferred PPO Member for copayment, deductible and coinsurance, but not including Noncovered Services, may not exceed the lesser of Group's Usual Charge or The Plan's Maximum Reimbursement Allowance.