Copayment Maximum Sample Clauses

Copayment Maximum. The maximum annual out-of-pocket amount for payment of Copayments, if any, to be paid by a Subscriber and any Covered Dependents.
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Copayment Maximum. Cost Shares set forth in this Rider do not apply toward the Copayment Maximum set forth in the Summary of Services and Cost Shares in your EOC to which this Rider is attached. The Rx Copayment and Rx Coinsurance set forth above will continue to apply even after the Copayment Maximum in your EOC has been met. This Outpatient Prescription Drug Rider is subject to all the terms and conditions of the Group Agreement and Group Evidence of Coverage to which this Rider is attached. This Rider does not change any of those terms and conditions, unless specifically stated in this Rider. XXXXXX FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. By: Xxxxx X. Xxxxxxx Vice President, Marketing, Sales & Business Development KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. 0000 Xxxx Xxxxxxxxx Xx., Xxxxxxxxx, XX 00000 301-816-2424 EXTERNAL PROSTHETIC AND ORTHOTIC DEVICES RIDER GROUP EVIDENCE OF COVERAGE This External Prosthetic and Orthotic Devices Rider (herein called “Rider”) is effective as of the date of your Group Agreement and Group Evidence of Coverage, and shall terminate as of the date your Group Agreement and Group Evidence of Coverage terminates. The following benefits, limitations, and exclusions for External Prosthetic and Orthotic Devices are hereby added to the Benefits Section of the Group Evidence of Coverage (herein referred to as the Group EOC), in consideration of the application and payment of the additional Premium for such services. External Prosthetic and Orthotic Devices
Sample 1
Copayment Maximum. The Copayment Maximum is the total amount of Copayments you must pay in a contract year for the Basic Health Services covered under this EOC as shown below. Once you have met the Copayment Maximum, you will not be required to pay any additional Copayments for these Basic Health Services. After two or more Members of a Family Unit combined have met the Family Copayment Maximum, the Copayment Maximum will be met for all Members of the Family Unit for the rest of the contract year. Basic Health Services. Except as excluded below, the following Services are considered “Basic Health Services” that apply toward the Copayment Maximum: • Inpatient and outpatient physician Services • Inpatient hospital Services • Outpatient medical Services • Preventive health care Services • Emergency Services • X-ray, laboratory and special procedures • Inpatient and outpatient chemical dependency and mental health Services Copayment Maximum Exclusions. The following Services, if c overed, are not considered “Basic Health Services” and do not apply toward your Copayment Maximum. Your Cost Share for these Services will continue to apply even after you have met your Copayment Maximum: • Outpatient drugs, supplies and supplements, including blood, blood products, and medical foods • Outpatient durable medical equipment and prosthetic and orthotic devices • Inpatient and outpatient infertility Services • Eyeglass lenses and frames, Contact lenses
Sample 1

Related to Copayment Maximum

  • Copayment A fixed amount You pay directly to a Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Cost-Sharing: Amounts You must pay for Covered Services, expressed as Copayments, Deductibles and/or Coinsurance. Cover, Covered or Covered Services: The Medically Necessary services paid for, arranged, or authorized for You by Us under the terms and conditions of this Contract. Deductible: The amount You owe before We begin to pay for Covered Services. The Deductible applies before any Copayments or Coinsurance are applied. The Deductible may not apply to all Covered Services. You may also have a Deductible that applies to a specific Covered Service that You owe before We begin to pay for a particular Covered Service. Dependents: The Subscriber’s Spouse and Children. Emergency Dental Care: Emergency dental treatment required to alleviate pain and suffering caused by dental disease or trauma. Refer to the Pediatric Dental Care and Adult Dental Care sections of this Contract for details.

  • Copayments Effective January 1, 2019, the State Dental Plan will cover allowable charges for the following services subject to the copayments 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 plan year and special cleanings (root or deep cleaning) as prescribed by the dentist. Service In-Network Out-of-Network Diagnostic/Preventive 100% 50% after deductible Fillings 80% after deductible 50% after deductible Endodontics 80% after deductible 50% after deductible Periodontics 80% after deductible 50% after deductible Oral Surgery 80% after deductible 50% after deductible Crowns 80% after deductible 50% after deductible Implants 80% after deductible 50% after deductible Prosthetics 80% after deductible 50% after deductible Prosthetic Repairs 80% after deductible 50% after deductible Orthodontics* 80% after deductible 50% after deductible

  • Annual maximums State Dental Plan coverage is subject to a one thousand dollar ($1,000) annual maximum benefit payable (excluding orthodontia) per person. "Annual" means per insurance year.

  • Orthodontia lifetime maximum Orthodontia benefits are subject to a three thousand dollar ($3,000) lifetime maximum benefit.

  • Lifetime maximums and non-prescription out-of-pocket maximums Coverage under Advantage is not subject to a per person lifetime maximum. In the first and second years of the contract, coverage under Advantage is subject to a plan year, non-prescription drug, out-of-pocket maximum of one thousand seven hundred dollars ($1,700) per person or three thousand four hundred dollars ($3,400) per family for members whose primary care clinic is in Cost Level 1 or Cost Level 2; two thousand four hundred dollars ($2,400) per person or four thousand eight hundred dollars ($4,800) per family for members whose primary care clinic is in Cost Level 3; and three thousand six hundred dollars ($3,600) per person or seven thousand two hundred dollars ($7,200) per family for members whose primary care clinic is in Cost Level 4.

  • – PREMIUM & OTHER PAYMENT 16.01 Overtime shall be paid for all paid hours over seven and one-half (7½) hours on a shift or seventy-five (75) hours bi-weekly at the rate of one and one-half (1½) times the employee's regular straight time hourly rate of pay. Overtime is subject to authorization by the Director of Nursing or designate. Authorization shall not be unreasonably withheld. In the event of an emergency, authorization may not be required.

  • Copayments and annual out-of-pocket maximums For the first and second year of the contract: Tier 1 copayment: Fourteen dollar ($14) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply. Tier 2 copayment: Twenty-five dollar ($25) copayment per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply. Tier 3 copayment: Fifty dollar ($50) copayment per prescription or refill for a Tier 3 drug dispensed in a thirty (30) day supply. Out of pocket maximum: There is an annual maximum eligible out-of-pocket expense limit for prescription drugs of eight hundred dollars ($800) per person or one thousand six hundred dollars ($1,600) per family.

  • Premium Payment The Bank shall pay any premiums due on the Policy.

  • Micropayments Fees You may qualify to receive micropayments pricing for the sale of goods and services through your PayPal account, if your transactions typically average less than $10. In order to qualify, you must have a PayPal account that is in good standing (for example, no limitations or negative PayPal balance), you may not be processing payments using PayPal Payments Pro and you must submit an application and have it approved by us. If your PayPal account is approved to accept micropayments, then the fees found on the Micropayment Fees table will apply to all transactions for the sale of goods or services processed through your PayPal account, instead of Merchant Services Fees. If you have multiple PayPal accounts, you must route your micropayments transactions through the appropriate account. Once a transaction is processed, PayPal will not re-route the transaction through a different account. PayPal Payouts If you are using PayPal Payouts (formerly Mass Pay), the terms of the PayPal Payouts Agreement will apply. Your responsibility to notify PayPal of pricing or fee errors Once you have access to any account statement(s) or other account activity information made available to you by PayPal with respect to your business account(s), you will have sixty (60) days to notify PayPal in writing of any errors or discrepancies with respect to the pricing or other fees applied by PayPal. If you do not notify PayPal within such timeframe, you accept such information as accurate, and PayPal shall have no obligation to make any corrections, unless otherwise required by applicable law. For the purposes of this provision, such pricing or fee errors or discrepancies are different than unauthorized transactions and other electronic transfer errors which are each subject to different notification timeframes as set forth in this user agreement.

  • Child Support Payments Child Support payments for the Children Outside the Couple shall be made by the ☐ Husband ☐ Wife to the ☐ Husband ☐ Wife in payments of $ due each month commencing on the 1st of the month following a petition for Divorce being filed in the jurisdiction of Governing Law (“Child Support”). Child Support shall continue until the first of the following events:

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