Network Covered Services Sample Clauses

Network Covered Services. When a Member incurs $7,150 in Deductible, Copayment and Coinsurance expenses for Network Covered Services furnished to the Member in one (1) Benefit Period, the benefits payable for claims received by the Plan for that Member during the remainder of the Benefit Period will increase to one hundred percent (100%) of the Plan Allowance. The dollar amount specified shall not include amounts in excess of the Plan Allowance.
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Network Covered Services. When Members under the same Family Coverage have Incurred $14,300 in Deductible, Copayment and Coinsurance expenses for Network Covered Services furnished to the Members in one (1) Benefit Period, the benefits payable for claims received by the Plan thereafter for all Members under that same Family Coverage during the remainder of the Benefit Period will increase to one hundred percent (100%) of the Plan Allowance. In the case of family coverage, no individual Member may contribute cost-sharing expenses greater than their Individual Out-of-Pocket Maximum. However, as each Member reaches their Individual Out-of-Pocket Maximum, the benefits payable for that Member will increase to 100% of the Plan Allowance for the remainder of the Benefit Period, whether or not the Family Out-of-Pocket Maximum has been met. The dollar amount specified shall not include amounts in excess of the Plan Allowance.
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Network Covered Services. When members under the same family coverage have incurred $8,000, in coinsurance expense for network covered services furnished to the members in one (1) benefit period, the benefits payable for claims received by the Plan thereafter for all members under that same family coverage during the remainder of the benefit period will increase to one hundred percent (100%) of the plan allowance. In the case of family coverage, benefits for any individual will not increase to one hundred percent (100%) of the plan allowance until the entire Family Out-of-Pocket Limit has been satisfied. The dollar amount specified shall not include any amounts paid for deductibles or amounts in excess of the plan allowance.
Sample 1

Related to Network Covered Services

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following: 1. All non-medically necessary services; 2. Sterilization of a mentally incompetent or institutionalized individual; 3. Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practices, who is responsible for the diagnosis or treatment of a particular patient’s condition; 4. All organ transplants, except for those specified in Appendix A; 5. Treatments for infertility5 and for the reversal of sterilization;

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • Hosting Services 13.1 If Supplier or its subcontractor, affiliate or any other person or entity providing products or services under the Contract Hosts Customer Data in connection with an Acquisition, the provisions of Appendix 1, attached hereto and incorporated herein, apply to such Acquisition. 13.2 If the Hosting of Customer Data by Supplier or its subcontractor, affiliate or any other person or entity providing products or services under the Contract contributes to or directly causes a Data Breach, Supplier shall be responsible for the obligations set forth in Appendix 1 related to breach reporting requirements and associated costs. Likewise if such Hosting contributes to or directly causes a Security Incident, Supplier shall be responsible for the obligations set forth in Appendix 1, as applicable. 14 Change Management

  • Shared Services CUPE agrees to adopt a shared services model that will allow other Trusts to join the shared services model. The shared services office of the Trust is responsible for the services to support the administration of benefits for the members, and to assist in the delivery of benefits on a sustainable, efficient and cost effective basis recognizing the value of benefits to the members.

  • Managed Services HP will provide the services as described in a Statement of Work (“SOW”) attached to this Agreement or incorporating it by reference. Each party will appoint a single point of contact as set forth in the SOW who will serve as their primary representative, have overall responsibility for managing performance, and meet with the other party’s representative to review progress. Change requests are governed by the change management procedures as set forth in the SOW.

  • Network Services Local Access Services In lieu of any other rates and discounts, Customer will pay fixed monthly recurring local loop charges ranging from $1,200 to $2,000 for TDM-based DS-3 Network Services Local Access Services at 2 CLLI codes mutually agreed upon by Customer and Company.

  • Transportation Services i) In the event that transportation services for a student served by CONTRACTOR pursuant to an Individual Services Agreement are to be provided by a party other than CONTRACTOR or the LEA or its transportation providers, such services shall be reflected in a separate agreement signed by the parties hereto, and provided to the LEA and SELPA Director by the CONTRACTOR. Except as provided below, CONTRACTOR shall compensate the transportation provider directly for such services, and shall charge the LEA for such services at the actual and reasonable rates billed by the transportation provider, plus a ten percent (.

  • Infertility Services This plan covers the following services, in accordance with R.I. General Law §27-20-20. • Services for the diagnosis and treatment of infertility if you are:

  • Interconnection Customer Compensation If the CAISO requests or directs the Interconnection Customer to provide a service pursuant to Articles 9.6.3 (Payment for Reactive Power) or 13.5.1 of this LGIA, the CAISO shall compensate the Interconnection Customer in accordance with the CAISO Tariff.

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