Common use of Determination of Benefits Clause in Contracts

Determination of Benefits. A Member’s financial responsibility for the costs of services will be calculated on the basis of when the service or supply is provided, not when payment is made. Benefits will be pro-rated to account for treatment or portions of stays that occur in more than 1 calendar year. It is solely within the discretion of HMO to determine when benefits are covered under this Certificate.

Determination of Benefits. A Member’s financial responsibility for the costs of services will be calculated on the basis of when the service or supply is provided, not when payment is made. Benefits will be pro-rated to account for treatment or portions of stays that occur in more than 1 calendar Calendar year. It is solely within the discretion of HMO to determine when benefits are covered under this Certificate.