Copayments, Coinsurance and Discount Sample Clauses

Copayments, Coinsurance and Discount. PROVIDER shall bill and collect all Copayments and Coinsurance from Member(s), which are specifically permitted and/or applicable to Member(s)’ benefit plan. PROVIDER shall bill and collect all charges from a Member for those Non-Covered Services provided to a Member. PROVIDER may only bill the Member when XXXXX has denied confirmation of eligibility for the service(s) and when the following conditions are met: (a) The Member has been notified by the PROVIDER of the financial liability in advance of the service delivery; (b) The notification by the PROVIDER is in writing, specific to the service being rendered, and clearly states that the Member is financially responsible for the specific service. A general patient liability statement which is signed by all patients is not sufficient for this purpose; (c) The notification is dated and signed by the Member; and (d) To the extent permitted by law, PROVIDER shall provide to Members either a courtesy discount of twenty percent (20%) off of PROVIDER’s usual and customary fees for the purchase of materials not covered by a Plan(s), and/or a discount of ten percent (10%) off of PROVIDER’s usual and customary fees for disposable contact lenses.
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Related to Copayments, Coinsurance and Discount

  • 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

  • Coinsurance After the deductible is satisfied, seventy percent (70%) coverage up to the plan out-of-pocket maximum designated below.

  • REINSURANCE PREMIUM The YRT Reinsurance Premium for each coverage shall equal (i) x (ii) x (iii) / 1,000, where:

  • Payment of Taxes, Insurance and Other Charges; Collections Thereunder With respect to each Mortgage Loan, the Seller shall maintain accurate records reflecting the status of ground rents, taxes, assessments and other charges which are or may become a lien upon the Mortgaged Property and the status of premiums for Primary Mortgage Insurance Policies and fire and hazard insurance coverage and shall obtain, from time to time, all bills for the payment of such charges (including renewal premiums) and shall effect payment thereof prior to the applicable penalty or termination date and at a time appropriate for securing maximum discounts allowable, employing for such purpose deposits of the Mortgagor in the Escrow Account which shall have been estimated and accumulated by the Seller in amounts sufficient for such purposes, as allowed under the terms of the Mortgage. To the extent that a Mortgage does not provide for Escrow Payments, the Seller shall determine that any such payments are made by the Mortgagor. The Seller assumes full responsibility for the timely payment of all such bills and shall effect timely payments of all such bills irrespective of each Mortgagor’s faithful performance in the payment of same or the making of the Escrow Payments and shall make Servicing Advances to effect such payments, subject to its ability to recover such Servicing Advances pursuant to Subsections 11.05(c), 11.05(d) and 11.07(b). No costs incurred by the Seller or subservicers in effecting the payment of ground rents, taxes, assessments and other charges on the Mortgaged Properties or mortgage or hazard insurance premiums shall, for the purpose of calculating remittances to the Purchaser, be added to the amount owing under the related Mortgage Loans, notwithstanding that the terms of such Mortgage Loans so permit.

  • Payment of Premiums Each Borrower shall punctually pay all premiums or other sums payable in respect of the obligatory insurances effected by it and produce all relevant receipts when so required by the Security Trustee.

  • Health insurance premiums If you are unemployed and have received unemployment compensation for 12 consecutive weeks under a federal or state program, you may take payments from your IRA to pay for health insurance premiums without incurring the 10 percent early distribution penalty tax.

  • 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

  • Insurance Costs (08/19) Contractor shall be financially responsible for all premiums, deductibles, self-insured retentions, and self-insurance.

  • Reinsurance Premiums A. The total Reinsurance Premium for the business ceded hereunder is the sum of the GMDB Reinsurance Premium, the EPB Reinsurance Premium and the GMIB Reinsurance Premium, each of which is defined separately in this article. B. The Reinsurance Premium rates and structure described above are subject to change in accordance with the criteria described in Article XV. GMDB AND EPB ------------ C. The total GMDB Reinsurance Premium for the business ceded hereunder is the sum of the GMDB Reinsurance Premium and the EPB Reinsurance Premium, each of which is defined separately in this article. GMDB CESSION PREMIUM -------------------- D. The GMDB Reinsurance Premium is expressed in terms of basis points and is defined in Exhibit II. E. The Cedent shall calculate, for each premium class, the Reinsurer's Percentage of the greater of the average aggregate GMDB value and the average aggregate account value for the reporting month. This value shall be applied to the GMDB Cession Premium rates per premium class on a 1/12th basis. EPB CESSION PREMIUM ------------------- F. The EPB Reinsurance Premium is an asset-based premium rate, expressed in terms of basis points, and is defined in Exhibit II. G. The Cedent shall calculate, for each premium class, the Reinsurer's Percentage of the average aggregate account value for the reporting month. This value shall be applied to the annualized EPB reinsurance premium rates per premium class on a 1/12th basis. The total EPB Cession Premium due for the month is the sum of the premiums calculated for each premium class. SPOUSAL CONTINUANCES -------------------- H. Spousal continuances will be covered under this Agreement to the extent that the surviving spouse satisfies the issue age restrictions and benefit limitations, as described in Schedule A, at time of continuance, and shall be deemed to be terminations followed by subsequent new issues for purposes of calculating Reinsurance Premiums. The new reinsurance premium rate applied shall be based off the attained age of the surviving spouse at the time of election of spousal continuance. After the termination of this Agreement for new cessions, a spousal continuation of a Reinsured Contract may be ceded to this Agreement in accordance with the procedure set forth in Article I, Paragraph D. GMIB ---- I. The GMIB cession premium ("GMIB Reinsurance Premium") is an asset-based premium rate, expressed in terms of basis points, as set forth in Exhibit II, and shall be calculated on an aggregate basis. J. The Cedent shall calculate the Reinsurer's Percentage of the greater of the average aggregate IBB value and the average aggregate account value for the reporting month. This value shall be applied to the annualized GMIB cession premium rates on a 1/12th basis.

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