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 EOC to which this Rider is attached. This Rider does not change any of those terms and conditions, unless specifically stated in this Rider. 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.
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. 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 Prosthetics 80% after deductible 80% after deductible 50% after deductible 50% after deductible Prosthetic Repairs 80% after deductible 50% after deductible Orthodontics 80% after deductible 50% after deductible

  • – 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. 16.02 When an employee is required to work on a paid holiday or on a day for which she is entitled to receive time and one-half (1½) her regular straight time hourly rate and she is required to work additional hours in excess of her normal seven and one-half (7½) hour shift on that day, she shall receive two (2) times her regular straight time hourly rate for such additional hours worked. 16.03 If an employee reports for work at the regularly scheduled time and no work is available, such employee will be paid a minimum of four (4) hours pay at her regular straight time hourly rate, provided the employee has not previously received notification orally or in writing not to report. 16.04 Where call-in is requested within one-half (½) hour of the starting time of the shift and the employee commences work within one (1) hour of the call, then the employee will be paid as if the entire shift had been worked, provided she completes the shift for which she was called in. 16.05 It shall be the responsibility of the employee to consult the posted work schedule. Changes to the posted schedule required by the Employer shall be brought to the attention of the employee. Where less than twenty-four (24) hours' notice is given to the employee personally, the employee will be paid four (4) hours’ straight time wages or six (6) hours’ straight time wages if an extended tour. It is understood that call-ins or call-backs are not covered by this provision. 16.06 If an employee works two consecutive shifts she shall be provided a meal by the Employer, or if a meal cannot be provided she shall receive a meal allowance of five dollars ($5.00).

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

  • Maximum In no event shall any holder be entitled to exercise any Warrant Shares to the extent that, after such exercise, the sum of the number of shares of Common Stock beneficially owned by any holder and its affiliates (other than shares of Common Stock which may be deemed beneficially owned through the ownership of the unexercised portion of the Warrant Shares or any unexercised right held by any holder subject to a similar limitation), would result in beneficial ownership by any holder and its affiliates of more than 4.99% of the outstanding shares of Common Stock (after taking into account the shares to be issued to the holder upon such exercise). For purposes of this Section 2(c), beneficial ownership shall be determined in accordance with Section 13(d) of the Securities Exchange Act of 1934, as amended. Nothing herein shall preclude the holder from disposing of a sufficient number of other shares of Common Stock beneficially owned by the holder so as to thereafter permit the continued exercise of this Warrant.

  • Maximum Payment The maximum period or aggregate of periods of accident make-up pay to be made by an Employer will be a total of 39 weeks for any one injury.

  • Premium Payments If an employee with at least three years of service in the employ of the Shaker Heights Board of Education should exhaust his/her sick leave within the time specifications of this contract and is granted a leave of absence by the Board, the Board shall continue to pay his/her premiums in accordance with his/her work assignment for the following fringe benefits for a period not to exceed twelve (12) months. The payment of such premiums will cease on the effective date an employee retires, resigns, goes on disability retirement or his/her contract is terminated. 1. PPO medical coverage 2. Prescription drug coverage

  • Applicable Expense Limit To the extent that the ordinary operating expenses incurred by the Fund in any fiscal year, including but not limited to investment advisory fees of the Advisor, but excluding interest, taxes, brokerage commissions, other investment-related costs and extraordinary expenses, such as litigation and other expenses not incurred in the ordinary course of the Fund’s business (“Fund Operating Expenses”), exceed the Operating Expense Limit, as defined in Section 1.2 below, such excess amount (the “Excess Amount”) shall be the liability of the Advisor to the extent set forth in this Agreement.

  • Premium Pay “Premium Pay” is a special pay rate for working during times that are less desirable, such as weekends, holidays or late shifts. The City will not pay the Consultant Premium Pay.

  • PREMIUM TAX The Reinsurer will not reimburse the Ceding Company for premium taxes.

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