PLAN PAYMENT AND MEMBER LIABILITY Sample Clauses
The "Plan Payment and Member Liability" clause defines how payments for covered services are handled between the health plan and the member. It typically outlines the portion of costs the plan will pay for eligible medical services and specifies the member’s financial responsibilities, such as copayments, deductibles, or coinsurance. This clause ensures that both parties understand their respective payment obligations, thereby preventing confusion and disputes over who is responsible for specific healthcare costs.
PLAN PAYMENT AND MEMBER LIABILITY. The Plan uses the Plan Allowance to calculate the benefit payable and the financial liability of the Member for Medically Necessary and Appropriate Services covered under this Agreement. In the case of Outpatient Prescription Drug benefits, the Plan uses the Provider’s Allowable Price for this calculation. See SECTION DE - DEFINITIONS of this Agreement for the definitions of “Plan Allowance” and “Provider’s Allowable Price”.
PLAN PAYMENT AND MEMBER LIABILITY. The Plan uses the plan allowance to calculate the benefit payable and the financial liability of the member for services and products covered under the Agreement. Plan allowance is
PLAN PAYMENT AND MEMBER LIABILITY. The Plan uses the Plan Allowance to calculate the benefit payable and the financial liability of the Member for Services covered under this Agreement. See SECTION DE - DEFINITIONS of this Agreement for the definitions of “Plan Allowance”.
PLAN PAYMENT AND MEMBER LIABILITY. The Plan uses the plan allowance to calculate the benefit payable and the financial liability of the member for Medically Necessary and Appropriate Services covered under the Agreement. In the case of prescription drug (outpatient) benefits, the Plan uses the provider’s allowable price for this calculation. See Section III, Subsection J. Benefit Amounts, Durations, Limits,