Allowable Charge means the amount from which the carrier's payment to a provider for any
Allowable Charge. The lesser of the billed charge or the amount established by Claims Administrator as the greatest amount this Contract will allow for a specific service covered under the terms of this Contract. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam – A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Authorization (Authorized) – A determination by Claims Administrator regarding a dental healthcare service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary – A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) – Coverage for dental services, treatments or procedures provided under this Contract. Benefits are based on the Allowable Charge for Covered Services and the Schedules of Dental Benefits.
Allowable Charge. The lesser of the billed charge or the amount established by UCD as the greatest amount this Contract will allow for a specific service covered under the terms of this Contract. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam – A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Authorization (Authorized) – A determination by UCD regarding a dental healthcare service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Dental Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary – A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) – Coverage for dental services, treatments or procedures provided under this Contract. Benefits are based on the Allowable Charge for Covered Services and the Schedules of Dental Benefits.
Examples of Allowable Charge in a sentence
This coverage shall include: Class I 100% benefit paid for Preventive & Diagnostic Care Class II 80% benefit paid for Basic Restorative Care Class III 80% benefit paid for Major Restorative Care Class IV 80% benefit paid for Orthodontia services; lifetime maximum $1,200 Out of network Class II, III, and IV claims will be paid at the Maximum Allowable Charge rate.
More Definitions of Allowable Charge
Allowable Charge. The lesser of the billed charge or the amount established by Xxxxx Vision as the maximum amount allowed for all Provider services covered under the terms of this Benefit Plan. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by Xxxxx Vision. Authorization (Authorized) – A determination by Xxxxx Vision that, based on the information provided, a Benefit satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Benefit(s) – Coverage for the benefits as described in Article IV and the Schedule of Vision Benefits. Benefits provided by the Company are based on the Allowable Charge.
Allowable Charge means the amount from which the carrier's payment to a provider for any covered item or service is determined before taking into account any cost-sharing arrangement.
Allowable Charge. Has the same meaning as defined in your EOC. See “Appendices - Definitions.” Brand Name Drug: A prescription drug that has been patented and is produced by only one manufacturer. Cost Share: Has the same meaning as defined in your EOC. FDA: The United States Food and Drug Administration.
Allowable Charge. The lesser of the billed charge or the amount established by Claims Administrator as the greatest amount this Benefit Plan will allow for a specific service covered under the terms of this Benefit Plan. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam – A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Annual Deductible – The dollar amount that each Member must pay out of their own pocket for Covered Services within each Benefit Period before any Benefits are paid under this Benefit Plan. The Annual Deductible will be shown in the Schedule of Dental Benefits, which may be waived for certain services. Authorization (Authorized) – A determination by Claims Administrator regarding a dental healthcare service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary – A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) – Coverage for dental services, treatments or procedures provided under this Benefit Plan. Benefits are based on the Allowable Charge for Covered Services and the Schedules of Dental Benefits.
Allowable Charge. An amount that is not more than the allowance for the service or supply as determined by Us, based on a standard which is most often charged for a given service by a Provider within the same geographic area.
Allowable Charge means the charge which is the lesser of: 1) The actual charge, 2) the negotiated charge that a Preferred Provider has agreed to accept for service, or 3) the Usual and Customary Charge for a covered service.
Allowable Charge means the lesser of the amount payable under the terms of the pharmacy’s contract with the PBM for a covered medication or the cash price inclusive of all applicable customer discounts which a cash paying customer of the pharmacy pays for a covered medication.