Co-Payments. Effective January 1, 2020, the State Dental Plan will cover allowable charges for the following services subject to the co- payments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per year and special cleanings (root or deep cleaning) as prescribed by the dentist.
Co-Payments. A. The Contractor may submit service claims to Participants' private insurance carriers and/or to Medicare/Medicaid (if the Contractor is a Medicare/Medicaid provider) for co- payment reimbursement. Upon the insurance/Medicare/Medicaid payment exceeding the allowed co-payment amounts (as defined in Sections G.4.3.B-D), the Participant is no longer eligible for subsidy, pursuant to Section G.4.4. The Contractor is responsible for knowing and understanding the terms and requirements set forth by Medicare/Medicaid with regard to reimbursement.
B. For Participants who have demonstrated an ability to pay a co-payment per Section C.6 toward evaluation Services but whose evaluation is subsidized, the Contractor shall establish a MAXIMUM payment which the Contractor may collect from each Participant and Department’s subsidy Payment per evaluation. The Contractor shall provide the maximum payment amount which shall include the maximum co-payment expected to receive from the Participant plus (+) the maximum subsidized Payment expected to be received from Department (Section B.2).
C. For Participants receiving treatment in a group setting who have demonstrated an ability to pay a co-payment per Section C.6 toward treatment Services but whose treatment is subsidized, the Contractor shall establish a MAXIMUM payment which the Contractor may collect from each group Participant and Department’s subsidy Payment per group session. The Contractor shall provide the maximum payment amount which shall include the maximum co-payment expected to receive from the Participant plus (+) the maximum subsidized Payment expected to be received from the Department (Section B.2).
D. For Participants receiving treatment in an individual setting who have demonstrated an ability to pay a co-payment per Section C.6 toward individual treatment Services but whose treatment is subsidized, the Contractor shall establish a MAXIMUM payment which the Contractor may collect from each individual-therapy Participant and Department’s subsidy Payment per individual treatment session. The Contractor shall provide the maximum payment amount which shall include the maximum co-payment expected to receive from the Participant plus (+) the maximum subsidized Payment expected to be received from the Department (Section B.2).
E. Collection of co-payments shall be in accordance with the following requirements. The Contractor shall:
1. Not employ Participants in any manner to "work off" the fee;
2. Not terminate ...
Co-Payments. The Contractor shall not set co-payment amounts that exceed the Department’s Fee for Service co-payments. The co-payment requirements for the Medicaid Program can be found in 907 KAR 1:604. Any cost sharing imposed by the Contractor shall be in accordance with 42 C.F.R. §§447.50 through 447.82. The Department will calculate payments to the Contractor as set forth in 42 CFR 447.56(d). The actuarial value of the co-payments will be reflected in the Capitation Rate. The Department may exclude the collection of co-payments with at least ninety (90) days written notice to the Contractor.
Co-Payments. Effective January 1, 2006, the State Dental Plan will cover allowable charges for the following services subject to the co-payments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per year and special cleanings (root or deep cleaning) as prescribed by the dentist. Diagnostic/Preventive 100% 50% after deductible Fillings 60% after deductible 50% after deductible Endodontics 60% after deductible 50% after deductible Periodontics 60% after deductible 50% after deductible Oral Surgery 60% after deductible 50% after deductible Crowns 60% after deductible 50% after deductible Prosthetics 50% after deductible 50% after deductible Prosthetic Repairs 50% after deductible 50% after deductible Orthodontics* 50% after deductible 50% after deductible *Please refer to your certificate of coverage for information regarding age limitations for dependent orthodontic care.
Co-Payments. You understand that the Membership Fee does not affect the co- payments, co-insurance, or deductibles You are required to pay pursuant to the terms of Your insurance coverage. You will continue to be financially responsible for any co- payments,co-insurance, or deductible amounts required by Your insurers.
Co-Payments. (A) An adjustment to each bargaining unit member’s contribution percentage may be made based upon the member’s participation or non-participation in the Personal Health Assessment (PHA) or similar participation in specified preventive care, wellness, care management or related healthcare programs or initiatives. Members will be provided an alternative means to complete the web-based PHA tool, if requested by such member; and
(B) For plan years following 2010, the University may also allow a premium adjustment to be made for any covered spouse or same-sex domestic partner based on participation in the PHA or similar participation in specified preventive care, wellness, care management or related healthcare programs or initiatives; and
(C) Bargaining unit members may be offered the opportunity to enroll in plans other than the “core” plan, and will pay the difference between the applicable premium for the “core” plan and the total applicable premiums for the plan in which the member is enrolled. Only the fact of the member’s completion of the PHA or participation in a similar program shall be released to the University Office of Human Resources. Personal health information (PHI) gathered in the PHA or similar document, including member responses, risk scores or recommendations, shall be considered a confidential medical record and shall not be released to the University Office of Human Resources, the Department of Public Safety, the Division of Police, or any other party who is not directly involved in providing care or care management to the member or without the prior written consent of the member. The employer subsidy percentage of the applicable premium for full-time bargaining unit members enrolled in a university offered health plan will be set at the same amount as for all other non- bargaining unit staff at the University enrolled in the same health plan.
Co-Payments. You remain financially responsible for all co-payments, coinsurance and/or deductibles as defined by the terms of your insurance coverage for provision of covered services.
Co-Payments. Items or services furnished to an Indian directly by Indian Health Services, an Indian Tribe or Tribal Organization or an Indian Urban Organization (I/T/U), or through referral under contract health services are exempt from copayments, coinsurance, deductibles, or similar charge. All other MinnesotaCare Caretaker Adults may be charged co-payments that exceed the amounts allowed in the Minnesota Medicaid State Plan, as follows:
a) Up to $3 per non-preventive visit to a physician or other primary care provider;
b) Up to $3.50 per visit for non-emergency use of a hospital emergency department;
c) Up to $3 per prescription;
d) Up to $25 for eyeglasses; and
e) Co-payments totaling $30 or more paid by a pregnant woman after the date the pregnancy is diagnosed must be refunded. The following table summarizes the MinnesotaCare cost sharing provisions. MinnesotaCare Children (at or below 200% FPL) No premium None No more than State plan MinnesotaCare children (above 200% and at or below 275% FPL) Monthly premiums based on a sliding scale based on income and family size None No more than State plan MinnesotaCare Pregnant Women (at or below 275% FPL ) Monthly premiums based on a sliding scale based on income and family size None No more than State plan MinnesotaCare Caretaker Adults (at or below 275% FPL) Monthly premiums based on a sliding scale based on income and family size None $3 per visit for non-preventive visit $3.50 per visit for non- emergency use of the emergency room $3 for prescription drugs $25 for eyeglasses
Co-Payments. Certain covered services and benefits are subject to co-payments by Enrollees and their Dependents, as described in the enclosed Evidence of Coverage.
Co-Payments. It is the intent of the parties that co-payments be set at levels that will provide the highest long- term cost stability to both the City and employees.
