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”.
Appears in 9 contracts
Samples: Individual Comprehensive Major Medical Exclusive Provider Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Subscription Agreement, Individual Comprehensive Major Medical Preferred Provider Subscription Agreement
