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 $13,000 in Deductible and Coinsurance expenses for Network Covered Services received during 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 Deductible and Coinsurance 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 Services to be performed by Contractor under this Agreement may involve the performance of trade work covered by the provisions of Section 6.22(e) [Prevailing Wages] of the Administrative Code or Section 21C [Miscellaneous Prevailing Wage Requirements] (collectively, “Covered Services”). The provisions of Section 6.22(e) and 21C of the Administrative Code are incorporated as provisions of this Agreement as if fully set forth herein and will apply to any Covered Services performed by Contractor and its subcontractors.

  • Non-Covered Services MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following:

  • 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.”

  • Provision of Covered Services Contractor shall undertake commercially reasonable efforts to ensure that each Participating Provider Agreement and each subcontracting arrangement entered into by each Participating Provider complies with the applicable terms and conditions set forth in this Agreement, as mutually agreed upon by Covered California and Contractor, and which may include the following:

  • 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.

  • Shared Services 5.1.1 ETFO 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.

  • Bundled Services If Cable Services subject to the Franchise Fee required under this Section 6 are provided to Subscribers in conjunction with Non-Cable Services, the Franchise Fee shall be applied only to the value of the Cable Services, as reflected on the books and records of Franchisee in accordance with FCC or state public utility regulatory commission rules, regulations, standards or orders.

  • Services Rendered/Scope of Work The Contractor shall, in a satisfactory and proper manner as determined by the Authority, render the services described in Exhibit A, which is attached and made a part of this Agreement.

  • Mastectomy Services Inpatient This plan provides coverage for a minimum of forty-eight (48) hours in a hospital following a mastectomy and a minimum of twenty-four (24) hours in a hospital following an axillary node dissection. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with and upon agreement with you. If you participate in an early discharge, defined as inpatient care following a mastectomy that is less than forty-eight (48) hours and inpatient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one (1) home visit conducted by a physician or registered nurse.

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