Calendar Year Deductible Sample Clauses

Calendar Year Deductible. This amount, when applicable, must be satisfied each calendar year before AvMed’s payment will begin toward Covered Services received in the same calendar year. Subject to Section 12.10, only those expenses for Covered Services submitted on Claims to AvMed will be credited toward the Calendar Year Deductible, and only up to the applicable Allowed Amount or Maximum Allowable Payment. Certain Covered Services may not be subject to the Calendar Year Deductible, as shown in your Schedule of Benefits.
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Calendar Year Deductible. The Calendar Year Deductible is the amount of expenses you must incur in each 12-month period (January 1 through December 31) for Covered Services and supplies before this plan provides certain benefits. Copays do not count toward the Calendar Year Deductible. Covered Services received from In-Network Providers, except Prescription Drug services, that require a Copay do not apply to your Calendar Year Deductible. All Covered Services received from In-Network Providers that do not require a Copay will apply to your Calendar Year Deductible. The amount applied toward your Calendar Year Deductible for any Covered Service or supply will not exceed the Allowed Amount (please see the Definitions section in this Agreement). This plan has different Deductibles for services and supplies received from In-Network Providers, and for services and supplies received from Out-of-Network Providers. The Deductible for services from Out-of-Network Providers is called the Out-of- Network Deductible. The Individual Deductible is the fixed amount each Member must incur and satisfy before certain benefits of this plan are provided.
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Calendar Year Deductible a. Waived for routine examinations as prescribed under Preventive Care Services. b. Twenty-Five Dollars ($25.00) per person per calendar year for other procedures; maximum of three (3) deductibles per family per year.
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Calendar Year Deductible. For Plans with a Calendar Year Deductible, the De- ductible applies to all Covered Services and supplies furnished by Participating and Non-Participating Den- tists, except as specified in the Summary of Benefits which is attached to and made a part of this EOC. It is the amount which you must pay out of pocket for charges that would otherwise be payable for Dental Care Services and supplies. Charges in excess of the Allowable Amount do not apply toward the Deductible. This per Member Deductible applies separately to each covered Member each Calendar Year, except that no more than the Family Deductible amount is required of a Family in a Calendar Year. Note: The Deductible also applies to a newborn child or a child placed for adop- tion, who is covered for the first 31 days, even if appli- cation is not made to add the child as a Dependent on the Plan. The Calendar Year per Member and Family Deductible amounts, if applicable, are listed in the Summary of Benefits which is attached to and made a part of this EOC. PRECERTIFICATION OF DENTAL BENEFITS PROGRAM Before any course of treatment expected to cost more than $250 is started, you should obtain precertification of Benefits. Note: If your Plan provides special Implant Benefits, you must obtain precertification/prior autho- rization for these Benefits before services are provided or Benefits will be denied. Your Dentist should submit the recommended treat- ment plan and fees together with appropriate diagnostic x-rays to a Dental Plan Administrator. A Dental Plan Administrator will review the dental treatment plan to determine the Benefits payable under the Plan. The Benefit determination for the proposed treatment plan will then be promptly returned to the Dentist. When the treatment is completed, your claim form should be sub- mitted to a Dental Plan Administrator for payment de- termination. A Dental Plan Administrator will notify you of its determination within 30 days after receipt of the claim. The dental Plan provides Benefits for Covered Services at the most cost effective level of care that is consistent with professionally recognized standards of care. If there are two or more professionally recognized proce- dures for treatment of a dental condition, the Plan will in most cases provide Benefits based on the most cost effective procedure. The Benefits provided under the Plan are based on these considerations but you and your Dentist make the final decision regarding treatment. If your Plan provid...
Sample 1
Calendar Year Deductible. For Covered Retired Employees retiring on or after April 1, 1996, the calendar year deductible shall be as follows: (1) For employee with at least 15 years of service at the time of retirement: $225 per person/$250 per family; (2) For employee with less than 15 years of service at the time of retirement (who were hired prior to 4/1/96): $300 per person/$400 per family.
Sample 1
Calendar Year Deductible. Prudent Buyer Plan Providers & Related Health Providers Non-Prudent Buyer Plan Providers Individual Family $300 $900 $ 600 $ 1,800 Type of Services Description of Services What You Pay Prudent Buyer Plan Providers Non-Prudent Buyer Plan Providers* Hospital Services Inpatient Semi-private room/board, special care units and all medically necessary ancillary services and supplies 10% 10%* Hospital Services Outpatient Surgical room fee, radiation and chemotherapy treatment and renal dialysis 10% 10%* Non-emergency use of the emergency room 50% 50%* Physician Care Office visits $20 co-pay (No deductible) 10%* Note: This co-pay applies to the charge for the Physician visit only. Home and hospital visits obstetrical care surgery 10% 10%* Allergy testing, serum injections and medication dispensed or administered by a Physician 10% 10%* Preventive Care No charge No charge* Services (No deductible) (No deductible) *The Member's payment for Non-Prudent Buyer Plan Provider services is based on a strictly limited schedule of allowances, and Members must pay charges in excess of those scheduled amounts. Please refer to the sections entitled DETERMINATION OF THE MAXIMUM ALLOWED AMOUNT beginning on page 16 and SCHEDULES FOR NON-PRUDENT BUYER PLAN PROVIDERS beginning on page 121 for complete benefit information.
Sample 1
Calendar Year Deductible. The Calendar Year Deductible is the amount of expense you must incur in each 12‐month period (January through December) for Covered Services and supplies before this plan provides certain benefits. Covered Services, except Prescription Drug services, received from In‐Network Providers requiring a Copay do not apply to your Calendar Year Deductible. All Covered Services received from In‐Network Providers that do not require a Copay will apply to your Calendar Year Deductible. The amount applied toward your Calendar Year Deductible for any Covered Service or supply will not exceed the Allowed Amount (please see the Definitions section in this Agreement). Copays do not count toward the Calendar Year Deductible. This plan has different Deductibles for services received from In‐ Network Providers and for services received from Out‐of‐Network Providers. The Deductible for services from Out‐ of‐Network Providers is called the Out‐of‐Network Deductible.
Sample 1
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Related to Calendar Year Deductible

  • Limitation Year The Limitation Year is: (Choose (c) or (d)) [ x ] (c) The Plan Year. [ ] (d) The 12 consecutive month period ending every _____.

  • Salary Deductions Salaried employees (E-level classifications) who are permanently assigned to full-time job classifications are paid on a bi-weekly salary basis. Salaried employees are paid a bi-weekly salary based on a minimum of two (2) forty (40) hour workweeks. The bi-weekly salary received by salaried employees will not be reduced regardless of the number of hours the salaried employee actually works in any week in which the salaried employee performs any work except for the following deductions: (A) Deductions from a salaried employee's salary may be made for any workweek in which the salaried employee performs no work. (B) Deductions from a salaried employee's salary may be made when the employee absents himself from work for a full day or days for personal reasons, other than sickness or accident. This provision shall not prevent appropriate deductions from being made from any employee's vacation leave balance pursuant to Article 11 of this Agreement for absences of less than a day for personal reasons, other than sickness or accident. (C) Deductions from an employee's salary may be made when a salaried employee absents himself from work for a day (or days) for sickness or accident disability in accordance with the provisions of Articles 13 and 14 of this Agreement. (D) Deduction in a salaried employee's salary may be made for the initial or terminal week of the salaried employee if the salaried employee fails to work the entire workweek.

  • Calendar Applications/nominations of incoming students must reach the receiving institution by (the deadlines indicated herewith are not final and different dates might apply and can be agreed upon): CZ PT 15 June 30 November 15 June 30 November PT CZ 31 May 1 November 15 June 15 November CZ PT --- --- --- PT CZ --- --- --- The receiving institution will send its decision within 5 weeks after the deadline for mobility to PT and within 4 weeks after the deadline for mobility to CZ.

  • Elective Deferrals Any Employer contributions made to the Plan at the election of the Participant, in lieu of cash compensation, and shall include contributions made pursuant to a salary reduction agreement or other deferral mechanism. With respect to any taxable year, a Participant's Elective Deferral is the sum of all employer contributions made on behalf of such Participant pursuant to an election to defer under any qualified cash or deferred arrangement as described in section 401(k) of the Code, any salary reduction simplified employee pension described in section 408(k)(6), any SIMPLE IRA Plan described in §408(p), , any plan as described under section 501(c)(18), and any employer contributions made on the behalf of a Participant for the purchase of an annuity contract under section 403(b) pursuant to a salary reduction agreement. Elective Deferrals shall not include any deferrals properly distributed as excess annual addition. For years beginning after 2005, the term “elective Deferrals” includes Pre-tax Elective Deferrals and Xxxx Elective Deferrals. Pre-tax Elective Deferrals are a participant’s Elective Deferrals that are not includible in the participant’s gross income at the time deferred. The Employer may, if notification is made within a reasonable time and in a manner described in IRS Revenue Ruling 2000-8, 2000-7 IRB617, allow for negative elections. If such administrative provision applies and the Employee does not affirmatively elect to not participate and the Employee does not affirmatively elect a different amount (including no amount), a default amount shall be deducted from the Employee’s Compensation. Such default amount shall be part of the initial notification received by the Employer. If negative elections apply under the Plan, the Employer shall indicate whether the default shall be a pre-tax Elective Deferral or a Xxxx Elective Deferral in the Adoption Agreement.

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