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
Copayments. Members shall be required to pay applicable Copayments at the time of service. Payment of a Copayment does not exclude the possibility of an additional billing if the service is determined to be a non-Covered Service or if other Cost Shares apply.
Copayments. Effective January 1, 2018, 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.
Copayments. Except where stated otherwise, after You have satisfied the Deductible as described above, You must pay the Copayments, or fixed amounts, in the Schedule of Benefits section of this Contract for Covered Services. However, when the Allowed Amount for a service is less than the Copayment, You are responsible for the lesser amount.
Copayments. Effective with the 2022 insurance contract year, the Base Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Services provided through the UPlan are subject to the 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. Services In-Network Out-of-Network Diagnostic/Preventive 100% None Fillings 80% None Endodontics 80% None Periodontics 80% None Oral Surgery 80% None Crowns 80% None Prosthetics 50% None Prosthetic Repairs 50% None Orthodontics* 80% None *Please refer to your certificate of coverage for information regarding age limitations for dependent orthodontic care.
Copayments. A copayment is a set dollar amount you are responsible for paying to a health care provider for a covered service. A copayment is also called a copay. COINSURANCE Coinsurance is the percentage of the covered service that you are responsible to pay when you receive covered services.
Copayments. Provider shall collect and retain a Member’s applicable Copayment for Covered Services provided pursuant to this Agreement. Provider shall not waive a Member’s Copayment obligation. Notwithstanding the foregoing, Provider acknowledges that cost sharing for Members eligible for both Medicare and Medicaid/Medi-Cal (“Dual Eligible Members”) is limited to the cost sharing limits established by Medicaid/Medi-Cal. With respect to Covered Services provided to Dual Eligible Members, Provider shall accept payment by Blue Shield as payment-in-full for such Covered Services, or will separately bill the appropriate State source for any amounts above the Medicaid/Medi-Cal cost sharing limits.
Copayments. A copayment is typically a fixed dollar amount due at the time of service. Members may be required to pay copayments to a provider each time services are performed that require a copayment. Copayments, as shown in the Schedule of Benefits, are due at the time of service. Payment of a copayment does not exclude the possibility of a provider billing you for any non-covered services. Copayments do not count or apply toward the deductible amount, but do apply toward your maximum out-of-pocket amount. Coinsurance Amount A coinsurance amount is your share of the cost of a service. Members may be required to pay a coinsurance in addition to any applicable deductible amount(s) due for a covered service or supply. Payment of a coinsurance amount does not exclude the possibility of a provider billing you for any non-covered services. Coinsurance amounts do not apply toward the deductible, but do apply toward your maximum out-of-pocket amount. When the annual maximum out-of-pocket amount has been met, additional covered service expenses will be provided at 100 percent. Deductible The deductible amount means the amount of covered service expenses that must be paid by each/all members before any benefits are provided or payable. The deductible amount does not include any copayment amount or coinsurance amount. Not all covered service expenses are subject to the deductible amount. See your Schedule of Benefits for more details. Maximum Out-of-Pocket Amount You must pay any required copayments or coinsurance amounts required until you reach the maximum out-of- pocket amount shown on your Schedule of Benefits. After the maximum out-of-pocket amount is met for an individual, we will pay 100 percent of the cost for covered services. The family maximum out-of-pocket amount is two times the individual maximum out-of-pocket amount. For the family maximum out-of-pocket amount, once a member has met the individual maximum out-of-pocket amount, the remainder of the family maximum out-of- pocket amount can be met with the combination of any one or more members’ eligible expenses. After the maximum out-of-pocket amount is met for an individual, Ambetter pays 100 percent of eligible expenses for that individual. The family maximum out-of-pocket amount is two times the individual maximum out-of- pocket amount. Both the individual and the family maximum out-of-pocket amounts are shown in the Schedule of Benefits. For family coverage, the family maximum out-of-pocket amount can be met ...
Copayments. Providers will use this information to determine the copayment they may collect from Members at the time a service is rendered. Members should use the following list as a reference: PCP $$ -- PCP office visit copayment SPC $$ -- specialist office visit copayment ER $$ -- emergency room visit copayment UC $$ -- urgent care visit copayment AH $$ -- after normal business hours PCP office visit copayment (This copayment is in addition to the PCP office visit copayment) The Member’s ID card may also contain information regarding coverage for dental, vision, and prescription drug benefits. Preauthorization: The term preauthorization alerts providers that this element of a Member’s coverage is present. Members should refer to the Preauthorization Program attachment to this Agreement for more information. On the back of the ID card, members can find important additional information on: Preauthorization instructions and toll-free telephone number. General instructions for filing claims. Members should remember to destroy old ID cards and use only their latest ID card. Members should also contact Keystone’s Customer Service if any information on their ID card is incorrect or if they have questions. Listed below are some important things to do and to remember about a Member ID Card: Check the information on the ID Card for completeness and accuracy. Check that one ID Card is received for each enrolled family Member. Check that the name of the Primary Care Physician (or office) that was selected is shown on the ID Card. Also, please check the ID Card for each family Member to be sure the information on it is accurate. Call Keystone’s Customer Service Department if the ID Card is lost or there is an error on the card. Carry the ID Card at all times. Members must present an ID Card whenever they receive Medical Care. On the reverse side of the ID Card, Members will find information about medical services. There is even a toll-free number for use by Hospitals if they have questions about a Member’s coverage.
Copayments. There are no Copayments for Covered Services under this Policy.
