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 $4,000 in coinsurance expense 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 Provider’s Reasonable Charge. In the case of family coverage, benefits for any individual will not increase to one hundred percent (100%) of the Provider’s Reasonable Charge 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 Provider’s Reasonable Charge.

Out-of-Network Covered Services. When members under the same family coverage have incurred $4,000 in coinsurance expense 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 Provider’s Provider’s Reasonable Charge. In the case of family coverage, benefits for any individual will not increase to one hundred percent (100%) of the Provider’s Provider’s Reasonable Charge 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 Provider’s Provider’s Reasonable Charge.

Out-of-Network Covered Services. When members under the same family coverage have incurred $4,000 6,000 in coinsurance expense 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 Provider’s Reasonable Charge. In the case of family coverage, benefits for any individual will not increase to one hundred percent (100%) of the Provider’s Reasonable Charge 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 Provider’s Reasonable Charge.

Out-of-Network Covered Services. When members under the same family coverage have incurred $4,000 4,800 in coinsurance expense 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 Provider’s Provider’s Reasonable Charge. In the case of family coverage, benefits for any individual will not increase to one hundred percent (100%) of the Provider’s Provider’s Reasonable Charge 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 Provider’s Provider’s Reasonable Charge.

Out-of-Network Covered Services. When members under the same family coverage have incurred $4,000 6,000 in coinsurance expense 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 Provider’s Provider’s Reasonable Charge. In the case of family coverage, benefits for any individual will not increase to one hundred percent (100%) of the Provider’s Provider’s Reasonable Charge 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 Provider’s Provider’s Reasonable Charge.