Lifetime Maximum Unlimited Unlimited Sample Clauses

Lifetime Maximum Unlimited Unlimited. Notes: • All Medical and prescription drug deductibles, copayments and coinsurance apply toward the out -of-pocket maximum (excluding Non- Network Human Organ and Tissue Transplant (HOTT) Services) • Deductible(s) apply only to covered medical services listed with a percentage (%) coinsurance. However, the deductible does not apply to Emergency Room Services where a percentage (%) coinsurance applies to other covered services and may not apply to some Behavioral Health services where coinsurance applies • Network and Non-network deductibles and coinsurance and out-of-pocket maximums accumulate towards each other. • Dependent Age: to end of the month which the child attains age 26 • When allergy injections are rendered with a Physicians Home and Office Visit, only the Office Visit cost share applies. When the Office Visit cost share is a % coinsurance, deductible and coinsurance apply to allergy injections • No copayment/coinsurance means no deductible/copayment/coinsurance up to the maximum allowable amount. 0% means no coinsurance up to the maximum allowable amount. However, when choosing a Non-network provider, the member is responsible for any balance due after the plan payment. • PCP is a Network Provider who is a practitioner that specializes in family practice, general practice, internal medicine, ped iatrics, obstetrics/gynecology, geriatrics or any other Network provider as allowed by the plan. • SCP is a Network Provider, other than a Primary Care Physician, who provides services within a designated specialty area of practice. • Certain diabetic and asthmatic supplies have no deductible/copayment/coinsurance up to the maximum allowable amount at networ k pharmacies including diabetic test strips. • Benefit period = calendar year • Mammograms (Diagnostic) are no copayment/coinsurance in Network office and outpatient facility settings. • Behavioral Health Services: Mental Health and Substance Abuse benefits provided in accordan ce with Federal Mental Health Parity. • Preventive Care Services that meet the requirements of federal and state law, including certain screenings, immunizations and physician visits are covered.