Coverage Examples Sample Clauses

Coverage Examples. This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage. (9 months of in-network pre-natal care and a hospital delivery) (a year of routine in-network care of a well- controlled condition) (in-network emergency room visit and follow up care) ◼ The plan’s overall deductible $0 ◼ Specialist copayment $50 ◼ Hospital (facility) copayment $250 ◼ Other $0 This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) ◼ The plan’s overall deductible $0 ◼ Specialist copayment $50 ◼ Hospital (facility) copayment $250 ◼ Other $0 This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Durable medical equipment (glucose meter) ◼ The plan’s overall deductible $0 ◼ Specialist copayment $50 ◼ Hospital (facility) copayment $250 ◼ Other $0 This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Deductibles $0 Copayments $300 Coinsurance $0 Limits or exclusions $60 Deductibles $0 Copayments $1,000 Coinsurance $0 Limits or exclusions $20 Deductibles $0 Copayments $500 Coinsurance $0 Limits or exclusions $0 If you believe we have failed to provide a service, or think we have discriminated in another way, contact us to file a grievance. Office of Civil Rights Coordinator Phone: 000-000-0000 (voicemail) 000 X. Xxxxxxxx St. TTY/TDD: 000-000-0000 35th Floor Fax: 000-000-0000 Xxxxxxx, Xxxxxxxx 00000 Email: XxxxxXxxxxxXxxxxxxxxxx@xxxx.xxx You may file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at: U.S. Dept. of Health & Human Services Phone: 000-000-0000 000 Xxxxxxxxxxxx Xxxxxx XX TTY/TDD: 000-000-0000 Xxxx 000X, XXX Xxxxxxxx 0000 Xxxxxxxxx Xxxxxx: xxxxx://xxxxxxxxx.xxx...
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Coverage Examples. This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.
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Coverage Examples. These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans.
Sample 1
Coverage Examples. These examples show how this plan might cover medical care in given situations. Use these examples to
Sample 1
Coverage Examples. This is not a cost estimator. Sample care costs: Patient pays: Questions and answers about the Coverage Examples: What are some of the assumptions behind the Coverage Examples? What does a Coverage Example show? Does the Coverage Example predict my own care needs? Does the Coverage Example predict my future expenses? Can I use Coverage Examples to compare plans? Are there other costs I should consider when comparing plans?
Sample 1
Coverage Examples. These examples .show how '.this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans; m Amount owed to providers: $7,540 iii Plan pays $7,330 III Patient pays $210 Imll Amount c m PlanpaYl II Patient p
Sample 1

Related to Coverage Examples

  • Medical Coverage The Executive shall be entitled to such continuation of health care coverage as is required under, and in accordance with, applicable law or otherwise provided in accordance with the Company’s policies. The Executive shall be notified in writing of the Executive’s rights to continue such coverage after the termination of the Executive’s employment pursuant to this Section 3(d)(iv), provided that the Executive timely complies with the conditions to continue such coverage. The Executive understands and acknowledges that the Executive is responsible to make all payments required for any such continued health care coverage that the Executive may choose to receive.

  • Spousal Coverage Any new Participants to the COG, after June 30, 2015, with working spouses who have the ability to be covered under an insurance plan through his/her place of employment, will be required to take his/her plan as their primary plan. This provision does not apply to a participant who had insurance with one COG employer and immediately thereafter, moved to another COG employer. If the spouse is required to pay forty (40%) percent or more of the premium with his/her employer, the requirements of this section shall not apply.

  • Basic Life and Accidental Death and Dismemberment Coverage The Employer agrees to provide and pay for the following term life coverage and accidental death and dismemberment coverage for all employees eligible for an Employer Contribution, as described in Section 3. Any premium paid by the State in excess of fifty thousand dollars ($50,000) coverage is subject to a tax liability in accord with Internal Revenue Service regulations. An employee may decline coverage in excess of fifty thousand dollars ($50,000) by filing a waiver in accord with Minnesota Management & Budget procedures. The basic life insurance policy will include an accelerated benefits agreement providing for payment of benefits prior to death if the insured has a terminal condition. $10,000 - $15,000 $15,000 $15,000 $15,001 - $20,000 $20,000 $20,000 $20,001 - $25,000 $25,000 $25,000 $25,001 - $30,000 $30,000 $30,000 $30,001 - $35,000 $35,000 $35,000 $35,001 - $40,000 $40,000 $40,000 $40,001 - $45,000 $45,000 $45,000 $45,001 - $50,000 $50,000 $50,000 $50,001 - $55,000 $55,000 $55,000 $55,001 - $60,000 $60,000 $60,000 $60,001 - $65,000 $65,000 $65,000 $65,001 - $70,000 $70,000 $70,000 $70,001 - $75,000 $75,000 $75,000 $75,001 - $80,000 $80,000 $80,000 $80,001 - $85,000 $85,000 $85,000 $85,001 - $90,000 $90,000 $90,000 Over $90,000 $95,000 $95,000

  • Single Coverage The School District will pay up to $28.00 per month for individual coverage for each full-time teacher who qualifies for and enrolls in the School District's group dental insurance plan.

  • Contribution Formula - Basic Life Coverage For employee basic life coverage and accidental death and dismemberment coverage, the Employer contributes one-hundred (100) percent of the cost.

  • Medical and Dental Coverage The County and Union agree that this Memorandum of Understanding shall be reopened at the County's request to meet and confer to discuss and mutually agree upon changes related to the Medical and Dental Plans, benefits, and contribution rates.

  • Long Term Disability Insurance Plan The Employer shall provide a mutually acceptable long-term disability insurance plan, a copy of which shall appear in Appendix “A” – Long-Term Disability Insurance Plan. The plan shall provide post-probationary regular employees with salary continuation as per Appendix “A” until age sixty-five (65) in the event of a disability. The cost of the plan shall be borne by the Employer.

  • Dental Coverage Each employee covered by this agreement shall be eligible to participate in the City's dental program.

  • Long Term Disability Insurance The City shall provide to employees with six months continuous service a Long Term Disability (LTD) plan that provides, after a one hundred eighty (180) day elimination period, sixty percent (60%) salary (subject to integration) up to age sixty-five. Employees who receive payments under the LTD plan shall not be eligible to continue receiving payments under the City's Catastrophic Illness Program.

  • Life Coverage Paragraph 1: The Board shall provide a group term life coverage in the sum of