Cost Sharing Amounts Sample Clauses

Cost Sharing Amounts. Except for anti-psychotic drugs for which no copayment is required, Adult MinnesotaCare Enrollees shall pay copayments of twenty dollars ($20.00) per prescription for brand name drugs and six dollars ($6.00) per prescription for generic drugs, with a combined maximum of sixty dollars ($60.00) per month. Adult MinnesotaCare Enrollees shall pay copayments of twenty-five dollars ($25.00) per pair of eyeglasses. Non-preventive visit: Except for mental health or chemical dependency services which are exempt from this copayment, MinnesotaCare Enrollees shall pay a copayment of fifteen dollars ($15.00) per visit. For the purposes of this paragraph, a “visit” means an episode of service which is required because of an Enrollee’s symptoms, diagnosis, or established illness; and delivered in an ambulatory setting by a physician (including physician ancillary services visits billed under the physician’s NPI), chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist. Emergency department visit: Fifty dollars ($50.00), per visit. Emergency department visits resulting in an inpatient admission will be charged only the inpatient admission copayment. Inpatient hospital, one hundred and fifty dollars ($150.00), per admission. Outpatient hospital visit, twenty-five dollars ($25.00) per visit.‌ Ambulatory surgery, fifty dollars ($50.00) per visit. If ambulatory surgery is performed in an outpatient hospital setting, no additional outpatient hospital visit copayment described in (6) above will apply. Radiology service, twenty-five dollars ($25.00), one copayment per visit regardless of the number of procedures. The MCO agrees to waive the family deductible for MinnesotaCare Enrollees. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting.

Cost Sharing Amounts. Administrator will collect the applicable Cost- Sharing Amounts and any other applicable charges for Covered Prescription Services dispensed to Members, as specified via the POS System or in the Pharmacy Plan Specifications. Administrator may only discount, waive or otherwise reduce the applicable Cost-Sharing Amounts or other applicable charges in accordance with applicable Laws and Regulations. Administrator agrees that it shall not at any time seek reimbursement for Cost-Sharing Amounts from United or any Client. Under no circumstances shall “Cost-Sharing Amounts” include any Medicare Part A or B cost-sharing for Members with dual eligibility for Medicare and Medicaid where the applicable State is responsible for paying such amounts. Pursuant to 42 CFR § 422.504(g)(1)(iii), for Members with dual eligibility, Administrator will accept the payment from United or the applicable Client as payment in full, or xxxx the appropriate State source.

Cost Sharing Amounts. The Health Benefit Programs may require Covered Persons to pay deductibles, coinsurance, copayments or visit fees for certain Covered Services, which requirements may differ among Covered Persons. Whenever Provider provides Covered Services for which a permitted deductible, coinsurance, copayment or visit fee is due, Provider will collect and retain the deductible, coinsurance, copayment or visit fee. The amount payable by the Covered Person, when added to the amount payable by Payor, will not exceed the lesser of Provider’s actual charge or the amount set forth in the applicable Fee Schedule, or as otherwise allowed under this Agreement.

Cost Sharing Amounts. Effective January 1, 2016: