Reasonable and Customary Expenses definition

Reasonable and Customary Expenses means a charge which: a) is charged for medical treatment, supplies or medical services that are medically necessary to treat Insured’s condition; and b) does not exceed the usual level of Expenses for similar medical treatment, supplies or medical services in the locality where the expense is incurred; and c) does not include Expenses that would not have been made if no insurance existed.

Reasonable and Customary Expenses means fees and prices generally charged within the locality where performed, for Medically Necessary services and supplies required for treatment of cases of comparable severity and nature.

Reasonable and Customary Expenses means reasonable and customary surgical/medical treatment expenses within the scope of cover of this policy to treat the condition for which the insured person was hospitalised.

Examples of Reasonable and Customary Expenses in a sentence

• Penalties and amounts above the Preferred Allowance or Usual, Reasonable and Customary Expenses do not count toward the Out-of-Pocket Maximum.

• Covered Expense(s): Amounts payable by the Company to reimburse You for Your Expenses that are (i) for Medically Necessary services, supplies, care, or Treatment; (ii) due to Illness or Injury; (iii) prescribed, performed, or ordered by a Physician; (iv) Usual, Reasonable, and Customary Expenses; (v) incurred during the Period of Coverage; (vi) and which do not exceed the applicable amount shown in the Schedule of Benefits.

• Covered Expense(s): Amounts payable by the Company to reimburse You for Your Expenses that are (i) for Medically Necessary services, supplies, care, or Treatment; (ii) due to Illness or Injury; (iii) prescribed, performed, or ordered by a Physician; (iv) Usual, Reasonable, and Customary Expenses; (v) incurred during the Period of Coverage; and (vi) which do not exceed the applicable amount shown in the Schedule of Benefits.

• Covered Expense(s): Amounts payable by the Company to reimburse You for Your Expenses that are (i) for Medically Necessary services, supplies, care, or Treatment; (ii) due to Injury or Illness; (iii) prescribed, performed, or ordered by a Physician; (iv) Usual, Reasonable, and Customary Expenses; (v) incurred during the Period of Coverage; and (vi) which do not exceed the applicable amount shown in the Schedule of Benefits.

• Unless a legal obligation to maintain coverage, such as a Qualified Medical Child Support Order exists, the child’s coverage shall cease after the last day of the month the placement is terminated.SCHEDULE OF BENEFITS SECTION IV All Coverage is based on Reasonable and Customary Expenses unless otherwise specified.

• If You require medical treatment as a result of malaria, which can reasonably be attributed to being contracted whilst on Your Journey, and manifests itself within 21 days after Your return to Your Country of Residence, We will insure You for Reasonable and Customary Expenses up to a limit of R5 000.

• If You are hospitalized on the advice of a Doctor because of Conditions mentioned below which required you to undergo Bariatric Surgery during the Policy period, then We will pay You, Reasonable and Customary Expenses related to Bariatric Surgery Eligibility: For adults aged 18 years or older, presence of severe obesity documented in contemporaneous clinical records, defined as any of the following: BMI greater than and equal to 40 in conjunctions with any of the following severe comorbidities: 1.

• If You are hospitalized on the advice of a Doctor because of Conditions mentioned below which required you to undergo Bariatric Surgery during the Policy period, then We will pay You, Reasonable and Customary Expenses related to Bariatric SurgeryEligibility:For adults aged 18 years or older, presence of severe obesity documented in contemporaneous clinical records, defined as any of the following:BMI greater than and equal to 40 in conjunctions with any of the following severe co morbidities:1.

• This Policy shall provide cover:▪ within the limitations stated in the policy schedule;▪ for the actual, Reasonable and Customary Expenses incurred by the Insured Person;▪ for the services listed below;▪ that are prescribed and certified Medically Necessary by a Dentist or Dental Physician;▪ that are general accepted and scientifically recognized medical services, excluding any experimental or pioneering services; and▪ that have a Date of Service during the Benefit Period.

• Expenses that are in excess of Reasonable and Customary Expenses.

More Definitions of Reasonable and Customary Expenses

Reasonable and Customary Expenses means fees and prices gen- erally charged within the locality where performed, for Medically Necessary services and supplies required for treatment of cases of com- parable severity and nature.

Reasonable and Customary Expenses means a charge which: a) is charged for medical treatment, supplies or medical services that are medically necessary to treat Insured’s condition; and b) does not exceed the usual level of Expenses for similar medical treatment, supplies or medical services in the locality where the expense is incurred; and

Reasonable and Customary Expenses generally means those expenses consistent with the Company's Travel and Entertainment Policy and practices applied to executive management, or otherwise approved in advance, in writing, by the Compensation Committee and the Company's CEO.