Member’s Obligations. a. Calendar Year Deductible. This amount, when applicable, must be satisfied each calendar year before AvMed’s payment toward Covered Services will begin. Subject to Section 12.9, only those expenses for Covered Services submitted on Claims to AvMed will be credited toward the Calendar Year Deductible, and only up to the applicable Allowed Amount or Maximum Allowable Payment. Certain Covered Services may not be subject to the Calendar Year Deductible, as shown in your Schedule of Benefits. i. Self-only or Individual Calendar Year Deductible. The Self-only or Individual Calendar Year Deductible, when applicable, must be satisfied by each Member each calendar year before AvMed’s payment toward Covered Services will begin during that calendar year.
Appears in 6 contracts
Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract With Point of Service Rider, Medical and Hospital Service Contract
Member’s Obligations. a. Calendar Year Deductible. This amount, when applicable, must be satisfied each calendar year Calendar Year before AvMed’s payment toward Covered Services will begin. Subject to Section 12.912.10, only those expenses for Covered Services submitted on Claims to AvMed will be credited toward the Calendar Year Deductible, and only up to the applicable Allowed Amount or Maximum Allowable Payment. Certain Covered Services may not be subject to the Calendar Year Deductible, as shown in your Schedule of Benefits.
i. Self-only or Individual Calendar Year Deductible. The Self-only or Individual Calendar Year Deductible, Deductible when applicable, applicable must be satisfied by each Member Member, each calendar year Calendar Year, before AvMed’s payment toward Covered Services will begin during that calendar yearCalendar Year.
Appears in 2 contracts
Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract