Covered Services Received from an Out-Of-Network Sample Clauses

Covered Services Received from an Out-Of-Network. Provider i) Participating Facility Provider (within the Plan Service Area): The Plan’s coinsurance liability arises after the member’s deductible obligation is subtracted from the Provider’s Reasonable Charge. At that time, the Plan will pay seventy percent (70%) of the remaining amount and the member’s coinsurance obligation will be thirty percent (30%) of the remaining amount. The member is obligated to pay the coinsurance amount as well as any deductible amounts. The member, in addition to coinsurance and/or deductible obligations, is also responsible for any difference between the participating facility provider’s billed charge and the Plan’s payment. ii) Participating Facility Provider (within the Highmark Blue Shield Service Area): The Plan’s coinsurance liability arises after the member’s deductible obligation is subtracted from the Provider’s Reasonable Charge. At that time, the Plan will pay ninety percent (90%) of the remaining amount and the member’s coinsurance obligation will be ten percent (10%) of the remaining amount. The member is obligated to pay the coinsurance amount as well as any deductible amounts. The participating facility provider will accept the Plan’s payment, plus the member’s coinsurance and/or deductible obligations, as payment in full for covered services rendered to the member. iii) Participating Facility Provider (Out-of-Area): The Plan’s coinsurance liability arises after the member’s deductible obligation is subtracted from the Provider’s Reasonable Charge. At that time, the Plan will pay seventy percent (70%) of the remaining amount and the member’s coinsurance obligation will be thirty percent (30%) of the remaining amount. The member is obligated to pay the coinsurance amount as well as any deductible amounts. The participating facility provider will accept the Plan’s payment, plus the member’s coinsurance and/or deductible obligations, as payment in full for covered services rendered to the member.
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Related to Covered Services Received from an Out-Of-Network

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  • The Web Services E-Verify Employer Agent agrees to, consistent with applicable laws, regulations, and policies, commit sufficient personnel and resources to meet the requirements of this MOU.

  • DEPENDENT PERSONAL SERVICES 1. Subject to the provisions of Articles 16, 18 and 19, salaries, wages and other similar remuneration derived by a resident of a Contracting State in respect of an employment shall be taxable only in that State unless the employment is exercised in the other Contracting State. If the employment is so exercised, such remuneration as is derived therefrom may be taxed in that other State. 2. Notwithstanding the provisions of paragraph 1, remuneration derived by a resident of a Contracting State in respect of an employment exercised in the other Contracting State shall be taxable only in the first-mentioned State if: a) the recipient is present in the other State for a period or periods not exceeding in the aggregate 183 days in any twelve-month period commencing or ending in the tax year concerned, and b) the remuneration is paid by, or on behalf of, an employer who is not a resident of the other State, and c) the remuneration is not borne by a permanent establishment or a fixed base which the employer has in the other State. 3. Notwithstanding the preceding provisions of this Article, remuneration derived in respect of an employment exercised aboard a ship or aircraft operated in international traffic by a resident of a Contracting State, may be taxed in that State.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

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