NON-NETWORK BENEFIT Sample Clauses

NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • Non-network coverage for mental health and substance use treatment is subject to the same deductibles and coinsurance maximums as the non-network Hospital and Basic Medical coverages. • Covered expenses for non-network mental health and substance use treatment will be in- cluded in the combined deductible and combined coinsurance maximum as set forth in section 9.3(a) and (b) of this Article. * Effective January 1, 2024 when non-participating providers are used, benefits will be paid at the rate of 275 percent of the Medicare Physician Fee Schedule in effect on the date of service. Benefits will continue to be subject to deductible, coinsurance, and calendar year maximums.
Sample 1Sample 2Sample 3
NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • Non-network Mental Health inpatient and outpatient treatment services shall be subject to the same but separate non-network hospital component benefits and the same but separate non-participating provider basic medical benefits including deductible, co-insurance and reimbursement schedule. Ex- penses applied against the deductible and co-insurance levels indicated above will not apply against any deductible or co-insurance levels maximums under the Basic Medical portion of the Plan. Effective Sep- tember 1, 2013, covered expenses for non-network mental health and substance abuse treatment will be included in the combined deductible and combined co-insurance maximum as set forth in Article 39.6 (c) and (d) of the Agreement.
Sample 1Sample 2
NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • 30 inpatient days and 30 outpatient visits maximum per year for mental health treatment; • Inpatient and outpatient reimbursement will be no greater than 50 percent of the in- network discounted fees; • Inpatient deductible will be $2,000 per year and the outpatient deductible will be $500 per year; no out-of-pocket maximum; • The maximum lifetime benefit for non-network substance abuse services shall be $100,000. Effective January 1, 2007, the maximum lifetime benefit for non-network substance abuse services shall be increased to $250,000. • Medically necessary inpatient alcohol and substance abuse treatment will be limited to one stay per year and three stays per lifetime. There will be a maximum of 30 outpatient visits approved per calendar year. • 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.
Sample 1
NON-NETWORK BENEFIT. Mental Health Treatment: • Medically necessary non-network coverage for mental health treatment is subject to the same deductible and coinsurance maximums as the non-network Hospital and Medical benefits. - Substance Abuse Treatment • Effective January 1, 2010 the maximum lifetime benefit for non-network substance abuse services will be unlimited. • Medically necessary inpatient alcohol and substance abuse treatment will be unlimited. • Effective January 1, 2010 the maximum of 30 outpatient visits approved per calendar year will be eliminated. • Effective January 1, 2010 medically necessary non-network coverage for mental health treatment is subject to the same deductible and coinsurance maximums as the non-network Hospital and Medical benefits. • 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.
Sample 1
NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • Non-network coverage for mental health treatment is subject to the same deductibles and coinsurance maximums as the nonnetwork Hospital and Basic Medical Program coverages; • No out-of-pocket maximum; • Medically necessary inpatient alcohol and substance abuse treatment will be limited to one stay per year and three stays per lifetime. There will be a maximum of 30 outpatient visits approved per calendar year. Expenses applied against the deductible and copay levels indicated above will not apply against any deductible or copay levels or maximums under the basic medical portion of the Plan.
Sample 1
NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following pro- visions: • Non-network Mental Health inpatient and outpatient treatment services shall be subject to the same but separate non-network hospital component benefits and the same but separate non- participating provider basic medical benefits including deductible, coinsurance and reimburse- ment schedule. Expenses applied against the deductible and coinsurance levels indicated above will not apply against any deductible or coinsurance levels maximums under the Basic Medical portion of the Plan. Effective September 1, 2013, covered expenses for non-network mental health and sub- stance abuse treatment will be included in the combined deductible and combined coinsurance maximum as set forth in Article 39.6 (c) and (d) of the Agreement.
Sample 1

Related to NON-NETWORK BENEFIT

  • 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.

  • Public Benefit It is XR's understanding that the commitments it has agreed to herein, and actions to be taken by XR under this Settlement Agreement 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 XR that to the extent any other private party serves a notice and/or initiates an action alleging a violation of Proposition 65 with respect to XR's alleged failure to provide a warning concerning actual or alleged exposure to DEHP prior to use of the Covered 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 Covered Products addressed in this Settlement Agreement, provided that XR is in material compliance with this Settlement Agreement.

  • 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.

  • 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.

  • Multi-Year Planning The CAPS will be in a form acceptable to the LHIN and may be required to incorporate (1) prudent multi-year financial forecasts; (2) plans for the achievement of performance targets; and (3) realistic risk management strategies. It will be aligned with the LHIN’s then current Integrated Health Service Plan and will reflect local LHIN priorities and initiatives. If the LHIN has provided multi-year planning targets for the HSP, the CAPS will reflect the planning targets.

  • Intercarrier Compensation 5.5.1 Intercarrier compensation for seven (7) or ten (10) digit dialed calls originated by ITC^DeltaCom utilizing Local Switching shall apply as follows: 5.5.2 For calls terminating to a BellSouth End User or to an End User served by BellSouth resold services, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. 5.5.3 For calls terminating to a CLEC where such CLEC is utilizing a BellSouth switch port or port/loop combination to provide service to its End User, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. BellSouth will not charge the terminating CLEC for End Office Switching as set forth in Exhibit A at the terminating end office. 5.5.3.1 For calls terminating to third party carriers, such as CLECs, wireless carriers and independent companies, utilizing their own switches to serve their End Users, ITC^DeltaCom is required to enter into interconnection or traffic exchange agreements with such third parties for the exchange of traffic through BellSouth’s network. If ITC^DeltaCom does not have such an agreement with a third party carrier and BellSouth is charged termination charges by a third party terminating a call originated by ITC^DeltaCom, or if such third party carrier bills BellSouth for terminating such calls, despite the existence of such an agreement, then BellSouth may, at its option: 5.5.3.1.1 pay such charges as billed by the third party carrier and charge End Office Switching as set forth in Exhibit A to ITC^DeltaCom for each such call; or 5.5.3.1.2 pay such charges as billed by the third party carrier and ITC^DeltaCom will reimburse the full amount of such charges within thirty (30) days of BellSouth’s request for reimbursement. 5.5.3.2 Intercarrier compensation for seven (7) or ten (10) digit dialed calls terminating to ITC^DeltaCom utilizing Local Switching shall apply as follows: 5.5.3.2.1 For calls originated by a BellSouth End User or by an End User served by resold BellSouth services, BellSouth shall not charge ITC^DeltaCom for End Office Switching at the terminating end office for use of the network component; therefore, ITC^DeltaCom shall not charge BellSouth intercarrier compensation or any other charges for termination of such calls. 5.5.3.2.2 For calls originated by a CLEC where such CLEC is utilizing a BellSouth switch port or port/loop combination to provide service to its End User, BellSouth shall not charge ITC^DeltaCom for End Office Switching at the terminating end office for use of the network component; therefore, ITC^DeltaCom shall not charge the originating CLEC or BellSouth intercarrier compensation or any other charges for termination of such calls. 5.5.3.2.3 For calls originated by third party carriers, such as CLECs, wireless carriers and independent companies,utilizing their own switches to serve their End Users, ITC^DeltaCom is required to enter into interconnection or traffic exchange agreements with such third parties for the exchange of traffic through BellSouth’s network. ITC^DeltaCom may xxxx the third parties according to such agreements and shall not xxxx BellSouth for the exchange of traffic through BellSouth’s network. 5.5.3.3 Intercarrier compensation shall apply as follows for intralata 1+ dialed calls originated by ITC^DeltaCom utilizing Local Switching where ITC^DeltaCom uses BellSouth’s CIC for its End User’s LPIC: 5.5.3.3.1 For calls terminating to a BellSouth End User or to an End User served by BellSouth resold services, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. 5.5.3.3.2 For calls terminating to a CLEC where such CLEC is utilizing a BellSouth switch port or port/loop combination to provide service to its End User, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. BellSouth will not charge the terminating CLEC for End Office Switching at the terminating end office. In the event that BellSouth is charged termination charges by the CLEC, BellSouth may pay such charges and ITC^DeltaCom will reimburse BellSouth the full amount of such charges within thirty (30) days following BellSouth’s request for reimbursement. 5.5.3.3.3 For calls terminating to third party carriers, such as CLECs, wireless carriers and independent companies, utilizing their own switches to serve their End Users, ITC^DeltaCom is required to enter into interconnection or traffic exchange agreements with such third parties for the exchange of traffic through BellSouth’s network. If ITC^DeltaCom does not have such an agreement with a third party carrier and BellSouth is charged termination charges by a third party terminating a call originated by ITC^DeltaCom, or if such third party carrier bills BellSouth for terminating such calls, despite the existence of such an agreement, then BellSouth may, at its option: 5.5.3.3.3.1 pay such charges as billed by the third party carrier and charge End Office Switching as set forth in Exhibit A to ITC^DeltaCom for each such call; or 5.5.3.3.3.2 pay such charges as billed by the third party carrier and ITC^DeltaCom will reimburse BellSouth the full amount of such charges within thirty (30) days following BellSouth’s request for reimbursement. 5.5.3.4 Intercarrier compensation shall apply as follows for intralata 1+ dialed calls terminating to ITC^DeltaCom utilizing Local Switching where the originating carrier uses BellSouth’s CIC for its End User’s LPIC: 5.5.3.4.1 For calls originated by a BellSouth End User or by an End User served by BellSouth resold service, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office for use of the End Office Switching network component in terminating such calls. ITC^DeltaCom may charge BellSouth for intercarrier compensation at the End Office Switching as set forth in Exhibit A for such calls. ITC^DeltaCom shall not charge originating or terminating switched access rates to BellSouth for termination of such calls. 5.5.3.5 For calls originated by or terminating to interexchange carriers through a switched access arrangement, ITC^DeltaCom may xxxx the interexchange carrier in accordance with ITC^DeltaCom’s tariff and will not xxxx BellSouth any charges for such call. ITC^DeltaCom shall pay BellSouth applicable charges for the use of BellSouth’s network in accordance with the rates set forth in Exhibit A for originating and terminating such calls.

  • Education Allowance Provisions in existing Collective Agreements providing for educational allowances shall be continued in effect.

  • 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.

  • In-Service Education The parties recognize the value of in-service both to the employee and the Employer and shall encourage employees to participate in in-service. All employees scheduled by the Employer to attend in-service seminars shall receive regular wages.

  • 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.