PLAN ALLOWANCE Sample Clauses

PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member as set forth in SECTION SB - SCHEDULE OF BENEFITS of this Agreement, and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider, or Dentist, Telemedicine Provider, and Vision Provider, each of whom is a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider, or Dentist, Telemedicine Provider or Vision Provider, each of whom is a Network Provider, will accept the Plan Allowance, plus any Member liability, as payment-in-full for Covered Services. In the case of an In-Area Out-of-Network Provider, the Plan Allowance shall be based on an adjusted contractual allowance for like services rendered by a Network Provider in the same geographic region. The Member will be responsible for any difference between the Provider’s billed charges and the Plan’s payment. In the case of an Out-of-Area Provider, whether or not such Out-of-Area Provider has an agreement with the local licensee of the Blue Cross Blue Shield Association, the Plan Allowance shall be determined, for other than pediatric dental and vision care and telemedicine Covered Services, based on prices received from the local licensee in accordance with the Plan’s participation in the INTER-PLAN ARRANGEMENTS as set forth in SECTION GP - GENERAL PROVISIONS of this Agreement. 112. PRECERTIFICATION (CERTIFICATION) - a process whereby the Medical Necessity and Appropriateness of Inpatient admissions, Services or place of Services is determined by the Plan prior to, or after, an admission or the performance of a procedure or Service.
Sample 1Sample 2See All (4)
AutoNDA by SimpleDocs
PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member as set forth in SECTION SB - SCHEDULE OF BENEFITS of this Agreement, and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider, or Dentist, Telemedicine Provider, and Vision Provider, each of whom is a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider, or Dentist, Telemedicine Provider or Vision Provider, each of whom is a Network Provider, will accept the Plan Allowance, plus any Member liability, as payment-in-full for Covered Services. In the case of an In-Area Out-of-Network Provider, the Plan Allowance shall be based on an adjusted contractual allowance for like services rendered by a Network Provider in the same geographic region. The Member will be responsible for any difference between the Provider’s billed charges and the Plan’s payment. In the case of a Provider located Out-ofArea, whether or not such Provider has an agreement with the local licensee of the Blue Cross Blue Shield Association, the Plan Allowance shall be determined, for other than pediatric dental and vision care and telemedicine Covered Services, based on prices received from the local licensee in accordance with the Plan’s participation in the INTER-PLAN ARRANGEMENTS as set forth in SECTION GP - GENERAL PROVISIONS of this Agreement.
Sample 1
PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider will accept the Plan Allowance, plus any Member liability, as payment in full for Covered Services. In the case of a Network Dental Provider, the Plan Allowance is expressed in terms of the Maximum Allowable Charge.
Sample 1Sample 2
PLAN ALLOWANCE the amount used to determine payment by the Plan for Covered Services provided to a Member as set forth in SECTION SB - SCHEDULE OF BENEFITS of this Agreement, and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider or Dentist, Telemedicine Provider and Vision Provider, each of whom is a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider or Dentist, Telemedicine Provider or Vision Provider, each of whom is a Network Provider, will accept the Plan Allowance, plus any Member liability, as payment in full for Covered Services. In the case of an Out-of-Area Provider, the Plan Allowance shall be determined, for other than pediatric dental and vision care and telemedicine Covered Services, based on prices received from the local licensee of the Blue Cross Blue Shield Association in accordance with the Plan’s participation in the INTER-PLAN ARRANGEMENTS as set forth in SECTION GP - GENERAL PROVISIONS of this Agreement. 110. PLAN SERVICE AREA - the geographic area consisting of the following counties in western Pennsylvania: Allegheny Centre (Part) Forest Xxxxxx Xxxxxxxxx Clarion Xxxxxx Xxxxxx Xxxxxx Clearfield Huntingdon Somerset Bedford Xxxxxxxx Indiana Venango Xxxxx Elk Xxxxxxxxx Xxxxxx Xxxxxx Erie Xxxxxxxx Xxxxxxxxxx Cambria Xxxxxxx XxXxxx Xxxxxxxxxxxx Xxxxxxx 111. PRECERTIFICATION (CERTIFICATION) - a process whereby the Medical Necessity and Appropriateness of Inpatient admissions, Services or place of Services is determined by the Plan prior to, or after, an admission or the performance of a procedure or Service. 112. PREFERRED VALUE - the level of Network benefits providing for the lowest level of Member cost-sharing for Covered Services.
Sample 1Sample 2
PLAN ALLOWANCE. Effective October the Company will pro- vide on weekly paycheques, a payment of per week to in lieu of Company contributions formerly paid into the pension plan. This is based upon conditions expressed in letter of understanding attached. Effective January the Company will cease pay- ing employees per week on weekly paycheques, and make a lump sum payment of on December of each year. For those employees who do not work weeks during the calendar year, the amount will be
Sample 1
PLAN ALLOWANCE. Provided that Subtenant is in full compliance with this Sublease, Sublandlord agrees to contribute $0.12 per rentable square foot of the Subleased Premises (“Plan Allowance”) toward the cost of preparing Subtenant’s Plans based on the Approved Plans. Within thirty (30) days following Subtenant’s written request to Sublandlord, Sublandlord shall pay such sum to Subtenant, provided such written request may not be submitted until the Subtenant has delivered to Sublandlord all mechanics’ lien releases or other lien releases on account of Subtenant’s Work, which are notarized, unconditional and in recordable form or in such form as Sublandlord shall have approved. To the extent the Plan Allowance exceeds the costs of preparing Subtenant’s Plans, the excess amount will be applied toward the Improvement Allowance described in Section 5.4 below.
Sample 1
PLAN ALLOWANCE a. Employees will be responsible for choosing their own voice or data plan as well as their carrier. Employees may also, at his or her own expense, add extra services or equipment features, as desired. b. Employees will also be responsible for choosing their own equipment. There is no additional allowance for the purchase of cell phones, since most carriers offer a number of phones free in connection with a service plan. c. The Town will provide a flat-rate monthly taxable allowance, independent of the cell phone provider selected by the employee. The allowance amounts shown below will be reviewed annually and may be adjusted to reflect changes in available rate plans. d. The Town will pay only the approved allowance amount even if actual monthly costs may occasionally exceed the allowance as follows: i. $30.00 monthly taxable for base cell defined as a long-range, portable electronic device used for mobile communication which is connected to a cellular network of base stations. Cellular phones include basic phones, which may also provide texting capability. ii. $75.00 monthly taxable for Personal Digital Assistant (PDA) defined as a small handheld computer typically providing calendar, contacts, and note-taking applications, but may include other applications such as web browser and media player. PDA’s can access the Internet, intranets or extranets via Wi-Fi or wireless wide area networks; and Smartphone defined as a mobile phone offering advanced capabilities that are beyond that of a typical mobile phone, often with PC-like functionality. A Smartphone is a single device combining a cellular telephone with a personal digital assistant (PDA). e. All monthly allowances will be paid as a taxable “cellular allowance” to the employee’s regular paycheck and are subject to FICA, withholding and is considered non-pensionable. f. Exceptional usage situations which require cellular phone service beyond the normal usage and control of the employee will be reviewed and reimbursement (with appropriate documentation) may be approved by the appropriate Department Director and Town Manager.
Sample 1
AutoNDA by SimpleDocs
PLAN ALLOWANCE. The Benefit payment amount is based on the Plan Allowance on the date the Covered Drug is dispensed or the date the service is rendered.
Sample 1

Related to PLAN ALLOWANCE

  • Vacation Allowance Employees in permanent positions are entitled to vacation with pay. Accrual is based upon straight time hours of working time per calendar month of service and begins on the date of appointment to a permanent position. Increased accruals begin on the first of the month following the month in which the employee qualifies. Accrual for portions of a month shall be in minimum amounts of one (1) hour calculated on the same basis as for partial month compensation pursuant to Section 5.6 of this MOU. Vacation credits may be taken in one (1) minute increments but may not be taken during the first six (6) months of employment (not necessarily synonymous with probationary status) except where sick leave has been exhausted; and none shall be allowed in excess of actual accrual at the time vacation is taken.

  • Separation Allowance If a regular full-time or regular part-time employee resigns within thirty (30) days of receiving notice of layoff, the employee shall be entitled to a separation allowance of two (2) weeks for each year of continuous service to a maximum of (26) weeks pay, and, on production of receipts from an approved educational program, within twelve (12)months of resignation, may be reimbursed for tuition fees up to a of three thousand dollars ($3,000). The displacement procedure prescribed by Article shall not operate to permit more than two displacements and the third person so displaced shall only have the right to displace another employee who has lesser bargaining unit and who is the least senior employee in all lower or identical paying classifications in the bargaining unit. This will also apply to bumping into part-time which will mean another two (2) bumps provided that the full-time employee has more seniority. The Hospital shall give each employee the bargaining unit who has actually been laid off following the completion of the bumping process, and who is to be laid off for a period of more than thirteen (13)weeks, three (3)months notice in writing of the employee’s xxx-xxxxx at the discretion of the Hospital, pay in lieu of notice. In other cases of lay-off, that exceeds two weeks, the shall give an employee in the bargaining unit acquired one weeks notice, provided however, such notice shall not be required if the lay-off occurs because of emergencies. For example: power failure, act of God, equipment breakdown, or any other conditions beyond the reasonable control of the Hospital. Article as long as there is not a laid off senior employee who is eligible for an employee who is laid off, or an employee who has displaced an employee in another position as a result of the layoff, or an employee to work in a different position than the one the employee held prior to the layoff, be entitled to to the position the employee held prior to the layoff should it become vacant within twenty-four (24) months of the layoff, provided the employee remains qualified and able to the duties of the position. Employees who have been laid off (i.e. are no longer in the Hospital) for up to (24) calendar months shall be recalled to or lower-rated classifications in the order of their seniority, provided they have the qualifications and ability to perform the available work and this not require posting. The hospital shall notify the employee of recall by registered mail, addressed to the last address on record with the hospital. The notification shall state the job to which the employee is eligible to be and the date and time at which the employee is to report for work. An employee given notice of recall by registered have three (3) days after receipt of such notice to the employee's intention, in to return to work on the date specified by the Employer or another date as mutually agreed. Any employee who does not so shall be deemed to have ceased with the Employer. The Employer be entitled to rely, for ail purposes, on the latest address of the employee contained in the records of the Employer. No new employee shall be hired in a in which a layoff has taken place employees laid off from that classification or displaced out of the classification who have been laid off or displaced for up to twenty-four (24) calendar months and are eligible for recall as prescribed in this article have been given the opportunity to to work in the classification from which the employees were laid off or displaced.

  • Annual Allowance The Corporation shall pay to the Executive, in cash, in a lump sum, on the Payment Date an amount equal to two times the annual allowance to which the Executive is entitled as of the date of the Date of Termination (or, if higher, as of immediately prior to the Effective Date).

  • Retirement Allowance Prior to issuing notice of layoff pursuant to article 9.08(a)(ii) in any classification(s), the Hospital will offer early-retirement allowance to a sufficient number of employees eligible for early retirement under HOOPP within the classification(s) in order of seniority, to the extent that the maximum number of employees within a classification who elect early retirement is equivalent to the number of employees within the classification(s) who would otherwise receive notice of layoff under article 9.08(a)(ii). An employee who elects an early retirement option shall receive, following completion of the last day of work, a retirement allowance of two weeks' salary for each year of service, plus a prorated amount for any additional partial year of service, to a maximum ceiling of 26 weeks' salary, and, in addition, full-time employees shall receive a single lump-sum payment equivalent to $1,000 for each year less than age 65 to a maximum of $5,000 upon retirement."

  • Moving Allowance With the prior approval of the Agency Head and/or his/her Designee concerning reimbursable costs, employees involuntarily transferred to a new job location fifty miles or more from the employee’s old residence than the old residence was from the old job location shall be reimbursed for receipted moving expenses, as provided in the IRS guidelines. For the purposes of this section, promotions and the exercise of any bumping option shall be considered as a voluntary transfer. Notwithstanding the above, at the discretion of the Agency Head and/or his/her Designee, employees may be reimbursed for moving expenses. 9.6.1 If an employee, whose moving expenses (all or a part) have been paid, resigns within one calendar year of the move, the Agency Head and/or his/her Designee may require the employee to reimburse the Agency for a portion of the moving expenses, based on the length of time the employee worked after the move. 9.6.2 Employees who have been involuntarily transferred or have exercised bumping rights to another geographical location of the State shall be allowed up to twenty-four hours of time off with pay for the purpose of attending to their personal affairs in their present location and establishing their personal affairs in their new location. Such time off from work must be approved in advance by the Agency Head and/or his/her Designee.

  • Relocation Allowance An employee who is promoted and required by agency policy to relocate his residence shall be granted time off with pay for one workday for this purpose. In addition, the employee shall be granted travel time to the new location based on the most direct route. No employee will be credited with more than the number of hours in the employee’s regular workday and such time shall not be counted as hours worked for the purpose of computing compensatory time or overtime.

  • Tool Allowance (a) A tool allowance as set in the relevant Wage Tables in Appendix A per week shall be paid for all purposes to:- (i) Electrical workers at Grade EW 5 and beyond; (ii) Electrical workers performing the duties of: (A) Television Antenna Installer/Erector; (B) Television/Radio/Electronic Equipment Servicemen; and (iii) Apprentices - Contained within the relevant Apprentice Wage Rates.

  • Shift Allowance In addition to the wage specified in sub-clause (1), read with sub- clause (12), a normal shift worker shall, in respect of his shift hours worked in any week, be paid an additional 12,5% on such wage.

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

  • - Separation Allowances (a) Where an employee resigns within 30 days after receiving notice of layoff pursuant to article 9.08(a)(ii) that his or her position will be eliminated, he or she shall be entitled to a separation allowance of two (2) weeks' salary for each year of continuous service to a maximum of twelve (12) weeks' pay, and, on production of receipts from an approved educational program, within twelve (12) months of resignation, may be reimbursed for tuition fees up to a maximum of three thousand ($3,000) dollars. (b) Where an employee resigns later than 30 days after receiving notice pursuant to Article 9.08(a)(ii) that his or her position will be eliminated, he or she shall be entitled to a separation allowance of four (4) weeks' salary, and, on production of receipts from an approved educational program, within twelve (12) months of resignation, may be reimbursed for tuition fees up to a maximum of one thousand two hundred and fifty ($1,250) dollars."

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!