NETWORK BENEFIT Sample Clauses

NETWORK BENEFIT. Mental Health Coverage • Paid-in-full medically necessary hospitalization services and inpatient physician charges when provided by or arranged through the network. • Outpatient care provided by or arranged through the network will be covered subject to a $20 per visit copay. Effective January 1, 2019, the outpatient visit copayment will be $25. • The copayment for emergency room services will be $70. Effective January 1, 2019, the copayment for emergency room services will be $100. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. Alcohol and Other Substance Abuse Coverage • Paid-in-full medically necessary care for hospitalization or alcohol/substance abuse facilities when pro- vided by or arranged through the network; • Outpatient care provided by or arranged through the network will be subject to the participating provider office visit copay.
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NETWORK BENEFIT. Mental Health Coverage • Paid-in-full medically necessary hospital services and inpatient physician charges when provided by, or arranged through, the network; • Effective April 1, 2010, outpatient care provided by, or arranged through, the network will be covered subject to a $20 per visit copayment; • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. - Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider office visit copayment. - Benefit Maximums • Effective January 1, 2010 medically necessary inpatient alcohol and substance abuse treatment will be unlimited.
Sample 1
NETWORK BENEFIT. Mental Health Coverage • Paid in full medically necessary hospitalization services and inpatient physician charges when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be covered subject to a $18 per visit copayment. Effective July 1, 2009, the outpatient per visit copayment will increase to $20. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. - Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider $18 office visit copayment. Effective July 1, 2009, the outpatient per visit copayment will increase to $20. - Benefit Maximums • Effective January 1, 2010 medically necessary inpatient alcohol and substance abuse treatment shall be unlimited.
Sample 1
NETWORK BENEFIT. Mental Health Coverage • Paid-in-full medically necessary hospital services and inpatient physician charges when provided by, or arranged through, the network; • Effective April 1,2010, outpatient care provided by, or arranged through, the network will be covered subject to a $20 per visit copayment. • Up to three visits for crisis intervention provided by, or arranged through, the network will be covered without copay. - Alcohol and Other Substance Abuse Coverage • Paid in full medically necessary care for hospitalization or alcohol/substance abuse facilities when provided by, or arranged through, the network; • Outpatient care provided by, or arranged through, the network will be subject to the participating provider office visit copayment. - Benefit Maximums • Effective January 1,2010 medically necessary inpatient alcohol and substance abuse treatment will be unlimited. 12.14(b) NON-NETWORK BENEFIT - Mental Health Medically necessary care rendered outside of the network will be subject to the following provisions: • Coincident with the increase in the Basic Medical deductible and coinsurance, the mental health basic medical deductible and coinsurance will increase accordingly. • The methodology for calculating non-network inpatient and outpatient reimbursement will be the same as the methodology for non-rietwork hospital and medical services; - Substance Abuse • Medically necessary inpatient alcohol and substance abuse treatment will be unlimited effective January 1,2010. • Coincident with the increase in the Basic Medical deductible and coinsurance, the substance abuse deductible and coinsurance will increase accordingly effective January 1,2010. • Effective January 1, 2010 the methodology for calculating non-network inpatient and outpatient reimbursement will be the same as the methodology for non­ network hospital and medical services; • Expenses applied against the deductible and coinsurance levels indicated above will not apply against any deductible or coinsurance maximums under the basic medical portion of the Plan. Effective January 1, 2012, covered expenses for non-network mental health and substance abuse treatment will be included in the combined deductible and combined coinsurance maximum. - Disease Management - Under the Mental Health and Substance Abuse Program a disease management program for depression is available. Effective, March 31, 2010, or as soon as practicable, disease management programs for eating disorders, including appropria...
Sample 1

Related to NETWORK BENEFIT

  • Public Benefit It is Reaction Retail’s understanding that the commitments it has agreed to herein, and actions to be taken by Reaction Retail under this Settlement Agreement, would confer a significant benefit to the general public, as set forth in Code of Civil Procedure § 1021.5 and Cal. Admin. Code tit. 11, § 3201. As such, it is the intent of Reaction Retail that to the extent any other private party initiates an action alleging a violation of Proposition 65 with respect to Reaction Retail’s failure to provide a warning concerning exposure to DEHP prior to use of the Products it has manufactured, distributed, sold, or offered for sale in California, or will manufacture, distribute, sell, or offer for sale in California, such private party action would not confer a significant benefit on the general public as to those Products addressed in this Settlement Agreement, provided that Reaction Retail is in material compliance with this Settlement Agreement.

  • Lump Sum The Change Order cost is determined by mutual agreement as a lump sum amount changing the Contract Sum allowed for completion of the Work. The Change Order shall be substantiated by documentation itemizing the estimated quantities and costs of all labor, materials and equipment required as well as any xxxx-up used. The price change shall include the cost percent allowed for the Contractor's overhead and profit and, if eligible, Time Dependent Overhead Costs.

  • Survivor Benefit Upon the death of a regular employee who leaves a spouse and/or dependants enrolled in the Medical Services Plan, Dental Plan and Extended Health Benefit Plan, such enrolment may continue for twelve (12) months following the employee’s death, provided the enrolled family members pay the employee’s share of the cost of the premium for the plans. The Employer shall advise the survivor of this benefit.

  • Specific Benefits Without limiting the generality of Section 3.3, the Executive shall be entitled to paid vacation of not less than the greater of (a) 20 business days per year or (b) the number of paid business vacation days provided to other senior executives of the Company (to be taken at reasonable times in accordance with the Company’s policies). Any accrued vacation not taken during any year may be carried forward to subsequent years; provided, that the Executive may not carry forward more than ten business days of unused vacation in any one year.

  • Retirement Benefit Should the Director still be in the Directorship ------------------ of the Association upon attainment of his 70th birthday, the Association will commence to pay him $590 per month for a continuous period of 120 months. In the event that the Director should die after becoming entitled to receive said monthly installments but before any or all of said installments have been paid, the Association will pay or will continue to pay said installments to such beneficiary or beneficiaries as the Director has directed by filing with the Association a notice in writing. In the event of the death of the last named beneficiary before all the unpaid payments have been made, the balance of any amount which remains unpaid at said death shall be commuted on the basis of 6 percent per annum compound interest and shall be paid in a single sum to the executor or administrator of the estate of the last named beneficiary to die. In the absence of any such beneficiary designation, any amount remaining unpaid at the Director's death shall be commuted on the basis of 6 percent per annum compound interest and shall be paid in a single sum to the executor or administrator of the Director's estate.

  • Retirement Benefits Due to either investment or employment during the marriage, either the Husband or Wife: (check one)

  • Educational Benefits The Employer agrees to provide educational benefits to employees that are in permanent status as of the first day of the quarter they are registering in accordance with the Employer’s space-available tuition waiver policy and employee 50% operating fee tuition waiver policy, to include:

  • Survivor Benefits 1. A surviving dependent of a retiree who was eligible to receive a Retiree Medical Grant, as stated above in A through C, and who qualifies for a monthly allowance shall be eligible for fifty (50) percent of the Grant authorized for the retiree. 2. A surviving eligible retiree who qualifies for a monthly retirement allowance who was married to a retiree who was also eligible for a Grant shall receive the survivor benefit described in D.1., above, or his or her own Grant, whichever is greater. Such retiree shall not be eligible for both Grants.

  • Economic Benefit The Bank shall determine the economic benefit attributable to the Executive based on the life insurance premium factor for the Executive’s age multiplied by the aggregate death benefit payable to the Beneficiary. The “life insurance premium factor” is the minimum factor applicable under guidance published pursuant to Treasury Reg. § 1.61-22(d)(3)(ii) or any subsequent authority.

  • Severance Benefit (a) If the employment of the Employee with the Company is terminated by the Company for any reason other than Cause (as defined below) or if the Employee terminates his or her employment with the Company for Good Reason (as defined below), the Company shall pay the Employee, from the date of termination, in addition to any payments to which the Employee is entitled under the Company’s severance pay plan, twelve (12) months of base salary at the Employee’s annual base salary level in effect at the time of such termination or immediately prior to the salary reduction that serves as the basis for termination for Good Reason. Employee will also be entitled to payment of an amount of cash equal to $20,000. The aggregate base salary and other cash amount payable shall be paid by the Company to the Employee in one lump sum on the first day following the six (6) month anniversary of the date of the Employee’s termination. For purposes of this Agreement, the term “termination” when used in the context of a condition to, or timing of, payment hereunder shall be interpreted to mean a “separation from service” as that term is used in Section 409A of the Code. (b) Employee will also be entitled to twelve (12) months of health benefits continuation if terminated under circumstances described in subpart (a) above. To the extent any such benefits cannot be provided to the Employee on a non-taxable basis and the provision thereof would cause any part of the benefits to be subject to additional taxes and interest under Section 409A of the Code, then the provision of such benefits shall be deferred to the earliest date upon which such benefits can be provided without being subject to such additional taxes and interest. (c) Solely for purposes of this Agreement, “Cause” shall include: i. the conviction of a felony, a crime of moral turpitude or fraud or having committed fraud, misappropriation or embezzlement in connection with the performance of his duties hereunder, ii. willful and repeated failures to substantially perform his assigned duties; or iii. a violation of any provision of this Agreement or express significant policies of the Company. (d) Solely for purposes of this Agreement, termination for “Good Reason” shall mean termination of employment by the Employee within ninety (90) days after:

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