Allowable Charges for Covered Services Sample Clauses

Allowable Charges for Covered Services. The sharing is expressed as a percentage. Once the Member has met any applicable Deductible, UCD's percentage will be applied to the Allowable Charge for Covered Services to determine the Benefits provided. Company – Means Blue Cross and Blue Shield of Louisiana, or United Concordia Dental when it acts on Blue Cross and Blue Shield of Louisiana’s behalf. Complaint – An oral expression of dissatisfaction with the dental plan or Provider services. Cosmetic Surgery/Treatment – Any operative procedure, treatment, or service, or any portion of an operative procedure, treatment or service performed primarily to improve physical appearance. An operative procedure, treatment or service is not considered Cosmetic Surgery or treatment if restores bodily function or corrects deformity to restore function of a part of the body that an Accidental Injury, disease, disorder or covered Surgery has altered.
Sample 1Sample 2Sample 3See All (9)
AutoNDA by SimpleDocs
Allowable Charges for Covered Services. The sharing is expressed as a percentage. Once the Member has met any applicable Deductible, Claims Administrator's percentage will be applied to the Allowable Charge for Covered Services to determine the Benefits provided. Company – Means Blue Cross and Blue Shield of Louisiana, or United Concordia Dental when it acts on Blue Cross and Blue Shield of Louisiana’s behalf. Complaint – An oral expression of dissatisfaction with the dental plan or Provider services. Cosmetic Surgery/Treatment – Any procedure or any portion of a procedure performed primarily to improve physical appearance. A procedure, treatment or service will not be considered Cosmetic Surgery or treatment if that procedure, treatment or service restores bodily function or corrects deformity of a part of the body that has been altered as a result of Accidental Injury, disease or disorder, or covered surgery.
Sample 1Sample 2
Allowable Charges for Covered Services. The sharing is expressed as a percentage. Once the Member has met any applicable Deductible, Claims Administrator's percentage will be applied to the Allowable Charge for Covered Services to determine the Benefits provided. Complaint – An oral expression of dissatisfaction with the dental plan or Provider services. Company – Means Blue Cross and Blue Shield of Louisiana. Cosmetic Surgery/Treatment – Any procedure or any portion of a procedure performed primarily to improve physical appearance. A procedure, treatment or service will not be considered Cosmetic Surgery or treatment if that procedure, treatment or service restores bodily function or corrects deformity of a part of the body that has been altered as a result of Accidental Injury, disease, disorder or covered surgery.
Sample 1Sample 2
Allowable Charges for Covered Services. The sharing is expressed as a pair of percentages, a percentage that We pay, and a Plan Participant percentage that You pay. Once the Plan Participant has met any applicable Deductible, the Plan Participant’s percentage will be applied to the Allowable Charges for Covered Services to determine the Plan Participant’s financial responsibility. The Plan Administrator's percentage will be applied to the Allowable Charge for Covered Services to determine the Benefits provided. Company – Blue Cross and Blue Shield of Louisiana (incorporated as Louisiana Health Service & Indemnity Company) or United Concordia Dental when it acts on Blue Cross and Blue Shield of Louisiana’s behalf. Complaint – An oral expression of dissatisfaction with the Claims Administrator or Provider services. Concurrent Review – A review of Medical Necessity, appropriateness of care, or level of care conducted during a course of treatment. Cosmetic Surgery/Treatment – Any procedure or any portion of a procedure performed primarily to improve physical appearance and/or treat a mental condition through change in bodily form. A procedure, treatment or service will not be considered Cosmetic Surgery or treatment if that procedure, treatment or service restores bodily function or corrects deformity of a part of the body that has been altered as a result of Accidental Injury, disease or covered surgery.
Sample 1
Allowable Charges for Covered Services. The sharing is expressed as a pair of percentages, a percentage that We pay, and a Plan Participant percentage that You pay. Once the Plan Participant has met any applicable Deductible, the Plan Participant’s percentage will be applied to the Allowable Charges for Covered Services to determine the Plan Participant’s financial responsibility. The Plan Administrator's percentage will be applied to the Allowable Charge for Covered Services to determine the Benefits provided. Company – Blue Cross and Blue Shield of Louisiana, or United Concordia Dental when it acts on Blue Cross and Blue Shield of Louisiana’s behalf. Complaint – An oral expression of dissatisfaction with the Claims Administrator or Provider services. Concurrent Review – A review of Medical Necessity, appropriateness of care, or level of care conducted during a course of treatment. Cosmetic Surgery/Treatment – Any procedure or any portion of a procedure performed primarily to improve physical appearance. A procedure, treatment or service will not be considered Cosmetic Surgery or treatment if that procedure, treatment or service restores bodily function or corrects deformity of a part of the body that has been altered as a result of Accidental Injury, disease or disorder, or covered surgery.
Sample 1
Allowable Charges for Covered Services. The sharing is expressed as a percentage. Once the Member has met any applicable Deductible, UCD's percentage will be applied to the Allowable Charge for Covered Services to determine the Benefits provided. Company – Means Blue Cross and Blue Shield of Louisiana, or United Concordia Dental when it acts on Blue Cross and Blue Shield of Louisiana’s behalf. Complaint – An oral expression of dissatisfaction with the dental plan or Provider services. Cosmetic Surgery/Treatment – Any procedure or any portion of a procedure performed primarily to improve physical appearance. A procedure, treatment or service will not be considered Cosmetic Surgery or treatment if Covered Service – A service or supply specified in this Benefit Plan for which Benefits are available when rendered by a Provider. Crown – A tooth-shaped cap that is placed over a tooth to cover it and restore its shape and size, strength, and improve its appearance. When a crown is cemented into place, it fully encases the entire visible portion of a tooth that lies at and above the gum line. Deductible – The dollar amount, if shown in the Schedule of Dental Benefits, of Allowable Charges for Covered Services that each Member must pay within a Benefit Period before payments are made under this Benefit Plan. If shown in the Schedule of Benefits, the Deductible may be waived for certain services. Dental Care and Treatment – All procedures, treatment, and surgery considered to be within the scope of the practice of dentistry, which is defined as that practice in which a person:
Sample 1
Allowable Charges for Covered Services. The sharing is expressed as a percentage. Once the Member has met any applicable Deductible, UCD's percentage will be applied to the Allowable Charge for Covered Services to determine the Benefits provided. Cosmetic Surgery/Treatment – Any operative procedure, treatment, or service, or any portion of an operative procedure, treatment or servcie performed primarily to improve physical appearance. An operative procedure, treatment or service is not considered Cosmetic Surgery or treatment if restores bodily function or corrects deformity to restore function of a part of the body that an Accidental Injury, disease, disorder or covered Surgery has altered.
Sample 1
AutoNDA by SimpleDocs

Related to Allowable Charges for Covered Services

  • Subcontract Costs Payments made by the Construction Manager to Subcontractors in accordance with the requirements of the subcontracts and this Agreement.

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Allowable Costs A. Allowable Costs are restricted to costs that are authorized under Texas Uniform Grant Management Standards (TxGMS) and applicable state and federal rules and laws. This Grant Agreement is subject to all applicable requirements of TxGMS, including the criteria for Allowable Costs. Additional federal requirements apply if this Grant Agreement is funded, in whole or in part, with federal funds. B. System Agency will reimburse Grantee for actual, allowable, and allocable costs incurred by Grantee in performing the Project, provided the costs are sufficiently documented. Grantee must have incurred a cost prior to claiming reimbursement and within the applicable term to be eligible for reimbursement under this Grant Agreement. At its sole discretion, the System Agency will determine whether costs submitted by Grantee are allowable and eligible for reimbursement. The System Agency may take repayment (recoup) from remaining funds available under this Grant Agreement in amounts necessary to fulfill Grantee’s repayment obligations. Grantee and all payments received by Grantee under this Grant Agreement are subject to applicable cost principles, audit requirements, and administrative requirements including applicable provisions under 2 CFR 200, 48 CFR Part 31, and TxGMS. C. OMB Circulars will be applied with the modifications prescribed by TxGMS with effect given to whichever provision imposes the more stringent requirement in the event of a conflict.

  • Medical Expenses 1. Employees exposed to hazardous physical, biological, or chemical agents shall be provided, at no cost to the employee, with medical examinations or evaluations required by VOSHA regulations. If there are no specific VOSHA regulations or standards for the agent in question, recommendations of the National Institute of Occupational Safety and Health or other generally recognized expert organization shall be used, as determined by the Commissioner of Health. 2. Employees determined by the Health Department to be at substantial risk for exposure to contagious diseases shall be provided appropriate vaccines. Groups at risk will be defined by the Vermont Department of Health. If no guidelines have been published by the Department of Health, the guidelines published by the Center for Disease Control in Atlanta, Georgia will apply. Vaccines and/or appropriate medical examinations will be provided at no cost to the employee according to applicable guidelines. 3. Any Department wishing to implement a Medical Monitoring Program on or after July 1, 1990, shall do so by conferring with the Health Department, and the Department of Human Resources. Prior to implementation, the Department of Human Resources shall notify VSEA. The parties shall meet within ten (10) days (unless mutually extended) after a request for negotiations by either party and thereafter on a regular basis for a period not exceeding forty-five (45) calendar days, after which the State may implement the program, whether or not the parties have bargained to genuine impasse. The VSEA shall retain all statutory impasse procedure rights as may be lawfully available to VSEA during the life of this Agreement, provided, however, the State at any time may withdraw its proposed medical monitoring program or terminate without further bargaining a medical monitoring program previously implemented, in which case, such retained statutory impasse procedure rights are extinguished.

  • Reimbursement of Travel Expenses If the Servicer provides access to the Review Materials at one of its properties, the Issuer will reimburse the Asset Representations Reviewer for its reasonable travel expenses incurred in connection with the Review on receipt of a detailed invoice.

  • Travel Expenses CONTRACTOR shall not be allowed or paid travel expenses unless set forth in this Agreement.

  • Allowable Expenses Contractor may submit for reimbursement, without mark-up, only the following categories of expense:

  • Reimbursement for Costs The Grantee shall be paid on a cost reimbursement basis for all eligible Project costs upon the completion, submittal, and approval of each deliverable identified in the Grant Work Plan. Reimbursement shall be requested on Exhibit C, Payment Request Summary Form. To be eligible for reimbursement, costs must be in compliance with laws, rules, and regulations applicable to expenditures of State funds, including, but not limited to, the Reference Guide for State Expenditures, which can be accessed at the following web address: xxxxx://xxx.xxxxxxxxxxxx.xxx/Division/AA/Manuals/documents/ReferenceGuideforStateExpenditures.pdf.

  • Training Costs All costs and expenses incurred by the Contractor in the training of its employees engaged in Petroleum Operations, and such other training as is required by this Agreement.

  • Child Care Expenses (a) Where an employee is requested or required by the Employer to attend: (i) Employer endorsed education, training and career development activities, or (ii) Employer sponsored activities which are not included in the normal duties of the employee's job, and are outside their headquarters or geographic location, such that the employee incurs additional child care expenses, the employee shall be reimbursed for the additional child care expenses up to $60 per day upon production of a receipt. (b) Where an employee, who is not on leave of absence, attends a course approved by the Employer outside the employee's normal scheduled work day such that the employee incurs additional child care expenses, the employee shall be reimbursed for the additional child care expense up to $30 per day upon production of a receipt. This reimbursement shall not exceed 15 days per calendar year. (c) Reimbursement in (a) or (b) shall only apply where no one else at the employee's home can provide the child care. (d) The receipt shall be a signed statement including the date(s), the hourly rate charged, the hours of care provided and shall identify the caregiver/agency.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!