Copayments, Coinsurances, Deductibles and Discounts Sample Clauses

Copayments, Coinsurances, Deductibles and Discounts. PROVIDER shall bill and collect all Copayments, Coinsurances and Deductibles 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 Member 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.
Sample 1
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Copayments, Coinsurances, Deductibles and Discounts. PROVIDER shall bill and collect all Copayments, Coinsurances and Deductibles from Member(s), which are specifically permitted and/or applicable to Member(s)’ benefit program. PROVIDER shall not refuse to provide Covered Services to an eligible Member of a Medicaid and/or Medicare Advantage plan solely because the Member is unable to pay the applicable Copayment. 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 a courtesy discount of twenty percent (20%) off PROVIDER’s usual and customary fees to Members 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.
Sample 1

Related to Copayments, Coinsurances, Deductibles and Discounts

  • Deductibles and Self-Insurance Retentions Any deductibles or self-insured retentions must be declared to and approved by the City. The City may require the Consultant to provide proof of ability to pay losses and related investigation, claims administration and defense expenses within the deductible or self-insured retention. The deductible or self-insured retention may be satisfied by either the named insured or the City.

  • Insurance, Loss Deductible The Customer shall be exempt from, and in no way liable for, any sums of money which may represent a deductible in any insurance policy. The payment of such deductible shall be the sole responsibility of the Contractor providing such insurance. Upon request, the Contractor shall furnish the Customer an insurance certificate proving appropriate coverage is in full force and effect.

  • 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.

  • 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.

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

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

  • Waiver of Subrogation, Reimbursement and Contribution Notwithstanding anything to the contrary contained in this Guaranty, Guarantor hereby unconditionally and irrevocably waives, releases and abrogates any and all rights it may now or hereafter have under any agreement, at law or in equity (including, without limitation, any law subrogating the Guarantor to the rights of Lender), to assert any claim against or seek contribution, indemnification or any other form of reimbursement from Borrower or any other party liable for payment of any or all of the Guaranteed Obligations for any payment made by Guarantor under or in connection with this Guaranty or otherwise.

  • Deductibles and Self-Insured Retention Any deductible or self-insured retention that apply to any insurance required by this Agreement must be declared and approved by COUNTY.

  • Deductibles and Self-Insured Retentions Any deductibles or self-insured retentions must be declared to, and approved by CITY's Risk Manager. At the option of CITY, either; the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects CITY, its officer, employees, agents and contractors; or GRANTEE shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses in an amount specified by the CITY's Risk Manager.

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