Member Cost Share. For certain Covered Services and depending on your plan design, you may be required to pay a part of the Maximum Allowed Cost (MAC) as your cost share amount (e.g., Deductible, Copayment, and/or Coinsurance). Your cost share amount and Out-of-Pocket Limits may vary depending on whether you received services from an In-Network or Out-of-network Provider. Specifically, you may be required to pay higher cost sharing amounts or may have limits on your benefits when using Out-of-Network Providers. Please see the Summary of Benefits and Coverage’s for your cost share responsibilities and limitations, or call Customer Service to learn how this plan’s benefits or cost share amounts may vary by the type of Provider you use. Alliant will not provide any reimbursement for Non-Covered services. You will be responsible for the total amount billed by your Provider for Non-Covered services, regardless of whether such services are performed by an In-Network or Out-of-Network Provider. Both services specifically excluded by the terms of your policy/plan and those received after benefits have been exhausted are Non-covered services. Benefits may be exhausted by exceeding, for example, day/visit limits. In some instances you may only be asked to pay the lower In-Network cost sharing amount when you use an Out-of-Network Provider. For example, if you go to an In-Network Hospital or Provider Facility and receive Covered Services from an Out-of-Network Provider such as a radiologist, anesthesiologist or pathologist who is employed by or contracted with an In-Network Hospital or facility, you will pay the In-Network cost share amounts for those Covered Services. However, you also may be liable for the difference between the Maximum Allowed Cost (MAC) and the Out-of- Network Provider’s charge.
Member Cost Share. Rates are inclusive of any applicable Member Copayment, Coinsurance or Deductible.
Member Cost Share. For certain Covered Services and depending on your Contract, You may be required to pay a part of the Maximum Allowed Amount as your Cost-Share amount (for example, Deductible, Copayment, and/or Coinsurance). Anthem will not provide any reimbursement for non-Covered Services. You will be responsible for the total amount billed by your Provider for non Covered Services, regardless of whether such services are performed by a Participating or Non-Participating Provider. Non-Covered Services include services specifically excluded from coverage by the terms of your Contract, and services received after benefits have been exhausted. Benefits may be exhausted by exceeding, for example, your day/visit limits In some instances you may only be asked to pay the lower Network Cost-Sharing amount when you use a Non-Participating Provider. For example, if you go to a Participating Hospital or Provider Facility and receive Covered Services from a Non-Participating Provider such as a radiologist, anesthesiologist or pathologist who is employed by or contracted with a Participating Hospital or facility, you will pay the Participating cost share amounts for those Covered Services. However, you also may be liable for the difference between the Maximum Allowed Amount and the Non-Participating Provider’s charge. Each family Member's Maximum Allowed Amount for Covered Services is applied to his/her individual Deductible. Once two or more family Members' Maximum Allowed Amount for Covered Services combine to equal the family Deductible, then no other Individual Deductible needs to be met for that calendar year. No one person can contribute more than his/her Individual Deductible to the Family Deductible. The Deductible applies to most Covered Services even those with a zero percent Coinsurance. An example of services not subject to the deductible is Network Preventive Care Services required by law. Generally, Copayments are not subject to and do not apply to the Deductible, however to confirm how your Plan works, please refer to the Schedule of Cost Shares and Benefits. The Deductible and Copayment/Coinsurance amount incurred in a calendar year apply to the Out-of- Pocket Limit. The Deductible, Coinsurance, and Copayment amounts incurred in a calendar year apply to the Out-of- Pocket Limit. The individual Out-of-Pocket Limit applies to each covered family member. Once two or more covered family members’ Out-of-Pocket Limits combine to equal the family Out-of-Pocket Limit amount,...
Member Cost Share. Administrator may, but shall not be obligated to, dispense or cause to be dispensed a prescription even if the prescription is not accompanied by the applicable Member Cost Share described above in this Exhibit A. Administrator will refund any amount submitted by a Member in excess of the Member’s applicable Member Cost Share. In the event a Member submits an insufficient Member Cost Share and the Member fails to remit the balance of the Member Cost Share amount to Administrator (or its designee) within thirty (30) days of Administrator’s (or its designee’s) request, then Administrator shall have the right to invoice Client for, and Client shall have an obligation to pay Administrator (or its designee), the amount of the uncollected Member Cost Share(s). Client shall, in turn, have the right to recover uncollected Member Cost Shares from its Members at Client’s determination. Shipping of prescriptions submitted without the appropriate Member Cost Share may be delayed.
Member Cost Share. For certain Covered Services and depending on your dental program, you may be required to pay a part of the Maximum Allowed Amount (for example, a Deductible and/or Coinsurance). Please see your plan’s Summary of Benefits and Coverage for your cost share responsibilities and limitations or call Customer Service at (000) 000-0000.
Member Cost Share. Members are responsible to pay the Member Cost Share, and any other costs or charges as described in the Health Plan Documents.
Member Cost Share. Rates are inclusive of any applicable Member financial responsibility.
