Copayments and annual out-of-pocket maximums Sample Clauses

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.
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Copayments and annual out-of-pocket maximums. For the first and second year of the contract: Tier 1 Copayment: Eighteen dollar ($18) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply.
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Copayments and annual out-of-pocket maximums. For the first year of the contract: Tier 1 copayment: Ten dollar ($10) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply. Tier 2 copayment: Sixteen dollar ($16) copayment per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply. Tier 3 copayment: Thirty-six dollar ($36) 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. For the second year of the contract: Tier 1 copayment: Twelve dollar ($12) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply. Tier 2 copayment: Eighteen dollar ($18) copayment per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply. Tier 3 copayment: Thirty-eight dollar ($38) 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.
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Copayments and annual out-of-pocket maximums. For each year of the contract: Formulary copayment: Fifteen dollar ($15) copayment per prescription or refill for a formulary drug dispensed in a thirty-four (34) day supply. Non-formulary copayment: Thirty dollar ($30) copayment per prescription or refill for a non-formulary drug dispensed in a thirty-four (34) day supply. Out-of-pocket maximum: There is an annual maximum eligible out-of-pocket expense limit for prescription drugs of six hundred fifty dollars ($650) per person or one thousand three hundred dollars ($1,300) per family.
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Copayments and annual out-of-pocket maximums. For the first and second year of the Contract:  Tier 1 co-payment: Twelve dollar ($12.00) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty day (30) supply.  Tier 2 co-payment: Eighteen dollar ($18.00) copayment per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply.  Tier 3 co-payment: Thirty-eight dollar ($38.00) 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 ($800.00) per person or one thousand six hundred dollars ($1,600.00) per family.
Sample 1
Copayments and annual out-of-pocket maximums. For the first year of the contract: Tier 1 copayment: Ten dollar ($10) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply. Tier 2 copayment: Sixteen dollar ($16) copayment Per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply. Tier 3 copayment: Thirty-Six dollar ($36) 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. For the first and second year of the contract: Tier 1 copayment: Twelve dollar ($12) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty
Sample 1
Copayments and annual out-of-pocket maximums. For each year of the contract: Formulary copayment: Fifteen dollar ($15) copayment per prescription or refill for a formulary drug dispensed in a thirty-four
Sample 1
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Related to Copayments and annual out-of-pocket maximums

  • 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.

  • 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.

  • Unobligated and Unearned Funds and Allowable Costs In accordance with Section 215.971, Florida Statutes, the Grantee shall refund to the State of Florida any balance of unobligated funds which has been advanced or paid to the Grantee. In addition, funds paid in excess of the amount to which the recipient is entitled under the terms and conditions of the agreement must be refunded to the state agency. Further, the recipient may expend funds only for allowable costs resulting from obligations incurred during the specified agreement period. Expenditures of state financial assistance must be in compliance with the laws, rules, and regulations applicable to expenditures of State funds, including, but not limited to, the Reference Guide for State Expenditures.

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