In-Network Benefits Sample Clauses

In-Network Benefits. In-network benefits are the highest level of coverage available. In-network benefits apply when Your care is provided by Participating Providers who are located within Our Service Area. You should always consider receiving dental care services first through the in-network benefits portion of this Contract.
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In-Network Benefits. In-network benefits are the highest level of coverage available. In-network benefits apply when Your care is provided by Participating Providers or Our affiliate’s network who are located within Our Service Area. You should always consider receiving dental care services first through the in-network benefits portion of this Contract. In-network care covered under this Contract must be provided, arranged or authorized in advance by Your Primary Care Dentist and, when required, approved by Us. In order to receive in-network benefits, You must contact Your Primary Care Dentist before You obtain the services except for Emergency Dental Care described in the Pediatric Dental Care section(s) of this Contract.
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In-Network Benefits. In order to be eligible to enroll and participate in this Plan you must work for an employer Group that is headquartered in the State of New Mexico (our Service Area). Your Dependents may be eligible to enroll if they meet all of the terms and conditions for such Coverage as described in the Eligibility, Enrollment and Effective Dates, Termination and Continuation of Coverage Section. When you or your Covered Dependents receive care from Practitioners and Providers in our network (In-network Practitioners/Providers), the In-network benefit level will apply to the cost of the Healthcare Services. You will be responsible for your Cost Sharing amounts (Copayments, Deductibles or Coinsurance) at the time of service. As shown in your Summary of Benefits and Coverage, your benefit levels are highest and your Out-of- pocket Cost Sharing amounts are lowest when you use our In-network Practitioner/Providers. Hospital Inpatient Admission and some other Healthcare Services require our review and Prior Authorization before the services are provided. If you seek care from an In-network Practitioner/Provider, your In-network Practitioner/Provider will notify us and handle all aspects of your care. Please refer to the Prior Authorization Section for complete details on Prior Authorization. You will find our In-network Practitioners/Providers close to where you live and work across the State. Our Provider Directory lists the In-network Practitioners, as well as In-network Hospitals,
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In-Network Benefits. In-network benefits are the highest level of coverage available. In-network benefits apply when Your care is provided by Participating Providers in Our Network affiliate’s EyeMed Network. You should always consider getting vision care services first through the in-network benefits portion of this Contract.
Sample 1
In-Network Benefits. Subject to the specifications described in the Schedule of Vision Benefits, each Member will have coverage for: 1. One Routine Eye Health Examination After Member’s payment of any applicable copayment stated on the Schedule of Vision Benefits, the Company will cover one Routine Eye Health Examination. Covered Routine Eye Health Examinations will include dilation of eye pupils when professionally indicated. Routine Eye Health Examinations will be limited to the frequency stated in the Schedule of Vision Benefits.
Sample 1
In-Network Benefits. To access care the employee and his/her eligible dependents must utilize a provider that participates in the insurance carrier's physician network. Most services under the OAP plan are covered at one hundred percent (100%) subject to minimal co-pay. Lifetime maximum benefit per individual is unlimited.
Sample 1
In-Network Benefits. To access care the employee and his/her eligible dependents must utilize a provider that participates in the insurance carrier's physician network. Most services under the POS plan are covered at one hundred percent (100%) subject to minimal co-pay. Lifetime maximum medical benefit per covered individual is unlimited. The plan requires the employee and his/her eligible dependents to designate a primary care physician (PCP). All medical services must be provided or authorized by the primary care physician. The primary care physician will oversee the patient's care and provide referral for specialty care.
Sample 1
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In-Network Benefits the level of benefits providing lower Cost Sharing Amounts for Members as shown in the Summary of Benefits.
Sample 1

Related to In-Network Benefits

  • Health Benefits For the eighteen (18) month period following the Termination Date, provided that Executive is eligible for, and timely elects COBRA continuation coverage, the Company will pay on Executive’s behalf, the monthly cost of COBRA continuation coverage under the Company’s group health plan for Executive and, where applicable, her spouse and dependents, at the level in effect as of the Termination Date, adjusted for any increase in such level paid by the Company for active employees, less the employee portion of the applicable premiums that Executive would have paid had she remained employed during the such eighteen (18) month period (the COBRA continuation coverage period shall run concurrently with the eighteen (18) month period that COBRA premium payments are made on Executive’s behalf under this subsection 1(a)(ii)). The reimbursements described herein shall be paid in monthly installments, commencing on the sixtieth (60th) day following the Termination Date, provided that the first such installment payment shall include any unpaid reimbursements that would have been made during the first sixty (60) days following the Termination Date. Notwithstanding the foregoing, the Company’s payment of the monthly COBRA premiums in accordance with this subsection 1(a)(ii) shall cease immediately upon the earlier of: (A) the end of the eighteen (18) month period following the Termination Date, or (B) the date that Executive is eligible for comparable coverage with a subsequent employer. Executive agrees to notify the Company in writing immediately if subsequent employment is accepted prior to the end of the eighteen (18) month period following the Termination Date and Executive agrees to repay to the Company any COBRA premium amount paid on Executive’s behalf during such period for any period of employment during which group health coverage is available through a subsequent employer. Notwithstanding the foregoing, the Company reserves the right to restructure the foregoing COBRA premium payment arrangement in any manner necessary or appropriate to avoid fines, penalties or negative tax consequences to the Company or Executive (including, without limitation, to avoid any penalty imposed for violation of the nondiscrimination requirements under the Patient Protection and Affordable Care Act or the guidance issued thereunder), as determined by the Company in its sole and absolute discretion.

  • Group Benefits To determine if a leave under the provisions of the Family and Medical Leave Act will be a paid or unpaid leave, contact the District’s Human Resources Department.

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