Network Benefits. Benefits - Benefits apply when you choose to obtain Covered Dental Care Services from a Network Dental Provider. Network Benefits are determined based on the contracted fee for each Covered Dental Service. In no event, will you be required to pay a Network Dental Provider an amount for a Covered Dental Service that is greater than the contracted fee. Payment Information
Network Benefits. Benefits - Benefits apply when you choose to obtain Covered Dental Care Services from a Network Dental Provider. Network Benefits are determined based on the contracted fee for each Covered Dental Service. In no event, will you be required to pay a Network Dental Provider an amount for a Covered Dental Service that is greater than the contracted fee. In order for Covered Dental Care Services to be paid, you must obtain all Covered Dental Care Services directly from or through a Network Dental Provider. You must always check the participation status of a provider prior to seeking services. From time to time, the participation status of a provider may change. You can check the participation status by contacting us and/or the provider. We can provide help in referring you to a Network Dental Provider. We will make available to you a Directory of Network Dental Providers. You can also call us at the number stated on your identification (ID) card to determine which providers participate in the Network. Benefits are not available for Dental Care Services that are not provided by a Network Dental Provider. Referral to Out-of-Network Specialist You may request a referral to an out-of-Network Dental Provider who is a non-Physician Specialist if a Covered Person is diagnosed with a condition or disease that requires specialized Dental Services, and: • There is no Network Dental Provider with the professional training and expertise to treat or provide Dental Services for the condition or disease; or • We cannot provide reasonable access to a Network Dental Provider with the professional training and expertise to treat or provide Dental Services for the condition or disease without unreasonable delay or travel. The Covered Person or Dental Provider requesting the referral must contact us to obtain our approval of the referral. The term "non-Physician Specialist" means a health care provider who: • Is not a Physician; • Is licensed or certified under the Maryland Health Occupations Article; and • Is certified or trained to treat or provide Dental Services for a specified condition or disease in a manner that is within the scope of the license or certification of the health care provider.
Network Benefits. The Network makes benefits available with your Account that are not part of this Agreement and are subject to change or cancellation. Details about Network benefits can be found in Apple Wallet or by reviewing xxxx.xxxxx.xxx.
Network Benefits. Benefits for Covered Services received from Network Providers (Providers contracted in the Preferred Care Network or another Blue Plan’s network).
Network Benefits. Benefits for Vision Care Services are determined based on the negotiated contract fee between us and the Vision Care Provider. Our negotiated rate with the Vision Care Provider is ordinarily lower than the Vision Care Provider's billed charge. Payment Information Annual Deductible Unless otherwise stated, Benefits for adult Vision Care Services provided under this section are not subject to any Annual Deductible stated in the Covered Health Care Services Schedule of Benefits. Vision Out-of-Pocket Limit - any amount you pay in Co-insurance for Vision Care Services under this section applies to the Out-of-Pocket Limit stated in the Covered Health Care Services Schedule of Benefits. Any amount you pay in Co-payments for Vision Care Services under this section applies to the Out-of-Pocket Limit stated in the Covered Health Care Services Schedule of Benefits. Benefits Information Table Vision Care Service What Is the Frequency of Service? Network Benefit - The Amount You Pay Based on the Contracted Rate Routine Vision Exam or Refraction only in lieu of a complete exam for Covered Persons 19 years of age and older Once every 12 months. None per exam. Not subject to payment of the Annual Deductible. Retinal Photography Once every 12 months. Copayment of $39 Not subject to payment of the Annual Deductible. Eyeglass Lenses Once every 12 months. • Single Vision Co-payment of $25 Not subject to payment of the Annual Deductible. • Bifocal Co-payment of $25 Not subject to payment of the Annual Deductible. • Trifocal Co-payment of $25 Not subject to payment of the Annual Deductible. • Lenticular Co-payment of $25 Vision Care Service What Is the Frequency of Service? Network Benefit - The Amount You Pay Based on the Contracted Rate Not subject to payment of the Annual Deductible. Optional Lens Extras* *Coverage for some Optional Lens Extras, which may include progressive lenses, may be included with eyeglass packages offered at some Network locations. Once every 12 months. Standard Scratch Coating None Not subject to payment of the Annual Deductible. Eyeglass Frames Up to $130 Once every 12 months. None Not subject to payment of the Annual Deductible. Contact Lenses* *If Contact Lenses that are not on the Formulary are prescribed; the member will be responsible for the Contact Lens Fitting and Evaluation -Coverage for Covered Contact Lens Formulary will not apply at Walmart, Sam's Club, and Costco locations. Other Network locations may not offer Formulary contact lenses....
Network Benefits. Members will have coverage for a Routine Eye Examination according to the terms of Schedule of Vision Benefits and as described below. In addition to the Routine Eye Examination, Members may have coverage for materials or laser vision correction services, as described below. The Schedule of Vision Benefits will state if the Member has coverage for materials and laser vision correction services.
Network Benefits. The Network makes benefits available with your Account that are not part of this Agreement and are subject to change or cancellation. Details about Network benefits can be found in the Wallet app. You will earn Daily Cash on every Purchase Transaction posted to your Account as described below: Transaction type Daily Cash percentage Goods or services purchased directly from Apple. These include purchases from Apple retail stores, the Apple online store, iTunes, Apple Music and other Apple-owned properties. App Store purchases (including In-App Purchases*). 3% of the transaction amount Apple Pay Purchase Transactions 2% of the transaction amount All other Purchase Transactions 1% of the transaction amount *"In-App Purchases" means content, services or functionality that you can buy for use in apps on your Apple devices, including premium content, digital goods and subscriptions. If any Purchase Transaction is covered by more than one Transaction type, the highest Daily Cash percentage will apply. For example, a Purchase Transaction at an Apple-owned retail store using Apple Pay would earn 3% Daily Cash, but would not also earn the 2% Daily Cash for Apple Pay transactions. You may earn Daily Cash as long as your Account remains open and in good standing, except as otherwise provided in this Agreement. Any accrued but unredeemed Daily Cash will not earn or accrue any interest, and we do not consider this Daily Cash when calculating the interest or Minimum Payment Due on your Account. Daily Cash will be calculated based on the amount of each Purchase Transaction posted to your Account, multiplied by the above-listed percentage corresponding to the Transaction type. Daily Cash will be rounded to the nearest cent but will not be less than one cent. EXCEPTIONS You will not earn 3% Daily Cash for purchases of Apple goods and services that are sold through third party retail or online stores, including any Apple authorized resellers, or if you make your payment through a third party wallet. You will not earn Daily Cash for transactions that are not permissible under this Agreement or on purchases made for purposes of resale.
Network Benefits. In order to be eligible to enroll and participate in this Plan you must work for an employer Group that is headquartered in the State of New Mexico (our Service Area). Your Dependents may be eligible to enroll if they meet all of the terms and conditions for such Coverage as described in the Eligibility, Enrollment and Effective Dates, Termination and Continuation of Coverage Section. When you or your Covered Dependents receive care from Practitioners and Providers in our network (In-network Practitioners/Providers), the In-network benefit level will apply to the cost of the Health Care Services. You will be responsible for your Cost Sharing amounts (Copayments, Deductibles or Coinsurance) at the time of service. As shown in your Summary of Benefits and Coverage, your benefit levels are highest and your Out-of- pocket Cost Sharing amounts are lowest when you use our In-network Practitioner/Providers. Your In-network Practitioner/Provider will xxxx us directly for the cost of services. You will generally not have claims to file or papers to fill out in order to be reimbursed for medical services obtained from In-network Practitioners and Providers. In-network Practitioners and Providers cannot xxxx you for any additional costs over and above your Cost Sharing amounts. Hospital Inpatient Admission and some other Health Care Services require our review and Prior Authorization before the services are provided. If you seek care from an In-network Practitioner/Provider, your In-network Practitioner/Provider will notify us and handle all aspects of your care. Please refer to the Prior Authorization Section for complete details on Prior Authorization. You will find our In-network Practitioners/Providers close to where you live and work across the State. Our Provider Directory lists the In-network Practitioners, as well as In-network Hospitals, pharmacies, outpatient facilities and other health care Providers. The Provider Directory is available on our website at xxxxx://xxx.xxx.xxx/Pages/find-a- doctor.aspx. If you need additional information about a Provider, you may call our Presbyterian Customer Service Center, Monday through Friday from 7 a.m. to 6 p.m. at (000) 000-0000 or 0-000-000-0000. Hearing impaired users may call the The Provider Directory is subject to change and you should always verify the Practitioner/Provider’s network status by visiting our website at xxxxx://xxx.xxx.xxx/Pages/find-a-doctor.aspx. When you obtain care from a Practitioner/Provider ...
Network Benefits. Benefits - Benefits apply when you choose to obtain Covered Dental Care Services from a Network Dental Provider. Network Benefits are determined based on the contracted fee for each Covered Dental Service. In no event, will you be required to pay a Network Dental Provider an amount for a Covered Dental Service that is greater than the contracted fee. In order for Covered Dental Care Services to be paid, you must obtain all Covered Dental Care Services directly from or through a Network Dental Provider. You must always check the participation status of a provider prior to seeking services. From time to time, the participation status of a provider may change. You can check the participation status by contacting us and/or the provider. We can provide help in referring you to a Network Dental Provider. We will make available to you a Directory of Network Dental Providers. You can also call us at the number stated on your identification (ID) card to determine which providers participate in the Network. Benefits are not available for Dental Care Services that are not provided by a Network Dental Provider.
Network Benefits. Hospital Inpatient. Inpatient hospital semi-private room and board, services and supplies, including blood and blood plasma will be reimbursed at 80% of allowable expenses after a $200 deductible per admission. Doctor's in-hospital consultations, radiologist's fees, anesthesiologist's fees, surgeon's fees and assistant surgeon's fees (in a hospital where an intern resident or a house staff member is not available) will be covered in full. Effective June 1, 2005, inpatient hospital services obtained at a network hospital will be covered in full after a $200 copayment per admission. Emergency Care. Covered services rendered in the Emergency Room of a hospital will be covered in full subject to a $15.00 copay. Effective June 1, 2005, the copayment will be $25.00. The copayment will be waived if the patient is admitted directly into the hospital from the Emergency Room. Emergency is defined as the sudden onset of symptoms of sufficient severity, including severe pain, that a prudent layperson could reasonably expect the absence of immediate care to put the members life in jeopardy, or cause serious impairment to bodily functions.
