Common use of Combined Limit Clause in Contracts

Combined Limit. The maximum total of In-Network and Out-of-Network Care available for designated health services in the Summary of Benefits and Coverage. Complications of Pregnancy Complications of Pregnancy result from conditions requiring Hospital confinement when the pregnancy is not terminated. The diagnoses of the complications are distinct from pregnancy but adversely affected or caused by pregnancy. Such conditions include acute nephritis, nephrosis, cardiac decompensation, missed or threatened abortion, preeclampsia, intrauterine fetal growth retardation and similar medical and surgical conditions of comparable severity. An ectopic pregnancy which is terminated is also considered a Complication of Pregnancy. Complications of Pregnancy shall not include false labor, cesarean section, occasional spotting, and Physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum and similar conditions associated with the management of a difficult pregnancy which are not diagnosed distinctly as Complications of Pregnancy. Congenital/developmental Anomaly A condition or conditions that are present at birth regardless of causation. Such conditions may be hereditary or due to some influence during gestation. Contract The Certificate in conjunction with the Group Health Care Contract, the Group Health Care Contract Application, the Alliant Formulary, any amendments or riders, your Identification Card and your Application for Enrollment constitutes the entire Contract. If there is any conflict between either this Certificate or the Group Health Care Contract and any amendment or rider, the amendment or rider shall control. If there is any conflict between this Certificate and the Group Health Care Contract, the Group Health Care Contract shall control. Contract Year A period of one year commencing on the Effective Date (or renewal date) and ending at 12:00 midnight on the last day of the one-year period. Coordination of Benefits A provision that is intended to avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment. It avoids claim payment delays by establishing an order in which plans pay their claims and providing an authority for the orderly transfer of information needed to pay claims promptly. It may avoid duplication of benefits by permitting a reduction of the benefits of a plan when, by the rules established by this provision, it does not have to pay its benefits first.

Combined Limit. The maximum total of In-Network and Out-of-Network Care NetworkCare available for designated health services in the Summary of Benefits and Coverage. Complications of Pregnancy Complications of Pregnancy result from conditions requiring Hospital confinement when the pregnancy is not terminated. The diagnoses of the complications are distinct from pregnancy but adversely affected or caused by pregnancy. Such conditions include acute nephritis, nephrosis, cardiac decompensation, missed or threatened abortion, preeclampsia, intrauterine fetal growth retardation and similar medical and surgical conditions of comparable severity. An ectopic pregnancy which is terminated is also considered a Complication of Pregnancy. Complications of Pregnancy shall not include false labor, cesarean section, occasional spotting, and Physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum and similar conditions associated with the management of a difficult pregnancy which are not diagnosed distinctly as Complications of Pregnancy. Congenital/developmental Developmental Anomaly A condition or conditions that are present at birth regardless of causation. Such conditions may be hereditary or due to some influence during gestation. Contract The Certificate in conjunction with the Group Health Care Contract, the Group Health Care Contract Application, the Alliant theAlliant Formulary, any amendments or riders, your Your Identification Card and your Your Application for Enrollment constitutes the entire Contract. If there is any conflict between either this Certificate or the Group Health Care Contract and any amendment or rider, the amendment or rider shall control. If there is any conflict between this Certificate and the Group Health Care Contract, the Group Health GroupHealth Care Contract shall control. Contract Year A period of one calendar year commencing on the Effective Date EffectiveDate (or renewal date) at 12:01am and ending at 12:00 midnight on the last day of the one-one- year periodperiod at 11:59 pm eastern time. Coordination of Benefits A provision that is intended to avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment. It avoids claim payment delays by establishing an order in which plans pay their paytheir claims and providing an authority for the orderly transfer of information needed to pay claims promptly. It may avoid duplication of benefits by permitting a reduction of the benefits of a plan when, by the rules established by this provision, it does not have to pay its benefits first. Copayment A cost sharing arrangement in which a Member pays a specified charge for a Covered Service. The Member is usually responsible for payment of the Copayment at the time health care is rendered. Copayments are distinguished from Coinsurance as flat dollar amounts rather than percentages of the charges for services rendered. Copayments may be collected by the Provider of service. Cosmetic Surgery Any non-Medically Necessary surgery or procedure, the primary purpose of which is to improve or change the appearance of any portion of the body, but which does not restore bodily function, correct a disease state, physical appearance or disfigurement caused by an accident, birth defect, or correct or naturally improve a physiological function. Cosmetic Surgery includes but is not limited to rhinoplasty, lipectomy, surgery for sagging or extra skin, any augmentation or reduction procedures (e.g., mammoplasty, liposuction, keloids, rhinoplasty and associated surgery) or treatment relating to the consequences or as a result of Cosmetic Surgery.

Combined Limit. The maximum total of In-Network and Out-of-Network Care available for designated health services in the Summary of Benefits and Coverage. Complications of Pregnancy Complications of Pregnancy result from conditions requiring Hospital confinement when the pregnancy is not terminated. The diagnoses of the complications are distinct from pregnancy but adversely affected or caused by pregnancy. Such conditions include acute nephritis, nephrosis, cardiac decompensation, missed or threatened abortion, preeclampsia, intrauterine fetal growth retardation and similar medical and surgical conditions of comparable severity. An ectopic pregnancy which is terminated is also considered a Complication of Pregnancy. Complications of Pregnancy shall not include false labor, cesarean section, occasional spotting, and Physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum and similar conditions associated with the management of a difficult pregnancy which are not diagnosed distinctly as Complications of Pregnancy. Congenital/developmental Anomaly A condition or conditions that are present at birth regardless of causation. Such conditions may be hereditary or due to some influence during gestation. Contract The Certificate in conjunction with the Group Health Care Contract, the Group Health Care Contract ApplicationCertificate, the Alliant Formulary, any amendments or riders, your Identification Card and your Application for Enrollment constitutes the entire Contract. If there is any conflict between either this Certificate or the Group Health Care Contract and any amendment or rider, the amendment or rider shall control. If there is any conflict between this Certificate and the Group Health Care Contract, the Group Health Care Contract shall control. Contract Year A period of one calendar year commencing on the Effective Date (or renewal date) January 1 at 12:01am and ending December 31 at 12:00 midnight on the last day of the one-year period11:59pm eastern time. Coordination of Benefits A provision that is intended to avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment. It avoids claim payment delays by establishing an order in which plans pay their claims and providing an authority for the orderly transfer of information needed to pay claims promptly. It may avoid duplication of benefits by permitting a reduction of the benefits of a plan when, by the rules established by this provision, it does not have to pay its benefits first. Copayment A cost-sharing arrangement in which a Member pays a specified charge for a Covered Service. The Member is usually responsible for payment of the Copayment at the time health care is rendered. Copayments are distinguished from Coinsurance as flat dollar amounts rather than percentages of the charges for services rendered. Copayments may be collected by the Provider of service.

Combined Limit. The maximum total of In-Network and Out-of-Network Care available for designated health services in the Summary of Benefits and Coverage. Complications of Pregnancy Complications of Pregnancy result from conditions requiring Hospital confinement when the pregnancy is not terminated. The diagnoses of the complications are distinct from pregnancy but adversely affected or caused by pregnancy. Such conditions include acute nephritis, nephrosis, cardiac decompensation, missed or threatened abortion, preeclampsia, intrauterine fetal growth retardation and similar medical and surgical conditions of comparable severity. An ectopic pregnancy which is terminated is also considered a Complication of Pregnancy. Complications of Pregnancy shall not include false labor, cesarean section, occasional spotting, and Physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum and similar conditions associated with the management of a difficult pregnancy which are not diagnosed distinctly as Complications of Pregnancy. Congenital/developmental Anomaly A condition or conditions that are present at birth regardless of causation. Such conditions may be hereditary or due to some influence during gestation. Contract The Certificate in conjunction with the Group Health Care Contract, the Group Health Care Contract ApplicationCertificate, the Alliant Formulary, any amendments or riders, your Identification Card and your Application for Enrollment constitutes the entire Contract. If there is any conflict between either this Certificate or the Group Health Care Contract and any amendment or rider, the amendment or rider shall control. If there is any conflict between this Certificate and the Group Health Care Contract, the Group Health Care Contract shall control. Contract Year A period of one calendar year commencing on the Effective Date (or renewal date) January 1 at 12:01am and ending December 31 at 12:00 midnight on the last day of the one-year period12:00pm midnight. Coordination of Benefits A provision that is intended to avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment. It avoids claim payment delays by establishing an order in which plans pay their claims and providing an authority for the orderly transfer of information needed to pay claims promptly. It may avoid duplication of benefits by permitting a reduction of the benefits of a plan when, by the rules established by this provision, it does not have to pay its benefits first. Copayment A cost-sharing arrangement in which a Member pays a specified charge for a Covered Service. The Member is usually responsible for payment of the Copayment at the time health care is rendered. Copayments are distinguished from Coinsurance as flat dollar amounts rather than percentages of the charges for services rendered. Copayments may be collected by the Provider of service. Cosmetic Surgery Any non-Medically Necessary surgery or procedure, the primary purpose of which is to improve or change the appearance of any portion of the body, but which does not restore bodily function, correct a disease state, physical appearance or disfigurement caused by an accident, birth defect, or correct or naturally improve a physiological function. Cosmetic Surgery includes but is not limited to rhinoplasty, lipectomy, surgery for sagging or extra skin, any augmentation or reduction procedures (e.g., mammoplasty, liposuction, keloids, rhinoplasty and associated surgery) or treatment relating to the consequences or as a result of CosmeticSurgery.