Negotiated Charge Clause Samples

Negotiated Charge. This is the maximum charge a Preferred Care Provider has agreed to make as to any service or supply for the purpose of the benefits under the Plan.

Negotiated Charge. As to the coverage provided under this Prescription Plan Rider, the amount HMO has established for each prescription drug obtained from a Participating Retail, Mail Order, or Specialty Pharmacy Network Pharmacy. The Negotiated Charge may reflect amounts HMO has agreed to pay directly to the Participating Retail, Mail Order, or Specialty Pharmacy Network Pharmacy, or to a third party vendor for the prescription drug, and may include an additional service or risk charge set by HMO. The Negotiated Charge does not include or reflect any amount HMO, an affiliate, or a third party vendor, may receive under a rebate arrangement between HMO, an affiliate or a third party vendor and a drug manufacturer for any prescription drug, including prescription drugs on the Drug Formulary. Based on its overall drug purchasing, HMO may receive rebates from the manufacturers of prescription drugs and may receive or pay additional amounts from or to third parties under price guarantees. These amounts will not change the Negotiated Charge under this Prescription Plan Rider. • Non-Formulary Prescription Drug(s). A product or drug not listed on the Drug Formulary which includes drugs listed on the Drug Formulary Exclusions List. • Participating Mail Order Pharmacy. A pharmacy, which has contracted with HMO, an affiliate, or a third party vendor, to provide covered outpatient prescription drugs or medicines, and insulin to Members by mail or other carrier.

Negotiated Charge. For health coverage: