Common use of Out-of-Network Covered Services Clause in Contracts

Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 in Deductible, Copayment and Coinsurance expenses for Out-of-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 Deductible, Copayment 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 one hundred percent (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.

Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 23,600 in Deductible, Copayment Deductible and Coinsurance expenses for Out-of-Network Covered Services furnished to the Members in 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 coverageFamily Coverage, no individual Member may contribute Deductible, Copayment Deductible and Coinsurance expenses expense greater than their his or her Individual Out-of-Pocket Maximum. However, as each Member reaches their his or her Individual Out-of-Pocket Maximum, the benefits payable for that Member will increase to one hundred percent (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.

Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 27,400 in Deductible, Copayment and Coinsurance expenses for Out-of-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 Deductible, Copayment 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 one hundred percent (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.

Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 in Deductible, Copayment and Coinsurance expenses for Out-of-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 coverageFamily Coverage, no individual Member may contribute Deductible, Copayment 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 one hundred percent (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.

Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 26,000 in Deductible, Copayment Deductible and Coinsurance expenses for Out-of-Network Covered Services furnished to the Members in 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 coverageFamily Coverage, no individual Member may contribute Deductible, Copayment 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 one hundred percent (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.

Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 27,600 in Deductible, Copayment and Coinsurance expenses for Out-of-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 coverageFamily Coverage, no individual Member may contribute Deductible, Copayment and Coinsurance 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 one hundred percent (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.

Out-of-Network Covered Services. When Members under the same Family Coverage have Incurred $28,600 24,000 in Deductible, Copayment Deductible and Coinsurance expenses for Out-of-Network Covered Services furnished to the Members in 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 coverageFamily Coverage, no individual Member may contribute Deductible, Copayment Deductible and Coinsurance expenses expense greater than their his or her Individual Out-of-Pocket Maximum. However, as each Member reaches their his or her Individual Out-of-Pocket Maximum, the benefits payable for that Member will increase to one hundred percent (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.