Protections from Unexpected Costs for Medical Services from Non-participating Providers Sample Clauses

Protections from Unexpected Costs for Medical Services from Non-participating Providers. Your plan contains provisions related to protection from surprise balance billing under Texas law. The federal laws provide additional financial protections for You when You receive some types of care from Providers who do not participate in Your network. If You receive the types of care listed below, Your in- network cost-sharing levels will apply to any in-network out-of-pocket maximums. Additionally, for services below that are governed by federal law (instead of state law), Your cost-share amount may be calculated on an amount that generally represents the median payment rate that BCBSTX has negotiated with Participating Providers for similar services in the area. • emergency care from facilities or Providers who do not participate in Your network; and • care furnished by non-participating Providers during Your visit to a Participating facility; and • air ambulance services from non-Participating Providers, if the services would be covered with a Participating Provider. Non-participating Providers may not bill You for more than Your Copayment for these types of services. There are limited instances when a non-participating Provider of the care listed above may send You a bill for up to the amount of that Provider’s billed charges. You are only responsible for payment of the non- participating Provider’s billed charges if, in advance of receiving services, You signed a written notice form that complies with applicable state and/or federal law. The requirements of federal law that impact Your costs for care from non-participating Providers may not apply in all cases. Sometimes, Texas law provisions relating to balance billing prohibitions may apply. You may contact BCBSTX at the number on the back of Your identification card with questions about claims or bills You have received from Providers.
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Related to Protections from Unexpected Costs for Medical Services from Non-participating Providers

  • Coordination, Oversight and Monitoring of Service Providers As set forth in the Administrative Services Agreement between the Fund and CRMC, CRMC shall coordinate, monitor and oversee the activities performed by the Service Providers with which AFS contracts. AFS shall monitor Service Providers’ provision of services including the delivery of Customer account statements and all Fund-related material, including summary prospectuses and/or prospectuses, shareholder reports, and proxies.

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  • Replacement of Key Personnel The Engineer must notify the State in writing as soon as possible, but no later than three business days after a project manager or other key personnel is removed from association with this contract, giving the reason for removal.

  • Services and Compensation Consultant shall perform the services described in Exhibit A (the “Services”) for the Company (or its designee), and the Company agrees to pay Consultant the compensation described in Exhibit A for Consultant’s performance of the Services.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • DEPENDENT PERSONAL SERVICES 1. Subject to the provisions of Articles 16, 18 and 19, salaries, wages and other similar remuneration derived by a resident of a Contracting State in respect of an employment shall be taxable only in that State unless the employment is exercised in the other Contracting State. If the employment is so exercised, such remuneration as is derived therefrom may be taxed in that other State. 2. Notwithstanding the provisions of paragraph 1, remuneration derived by a resident of a Contracting State in respect of an employment exercised in the other Contracting State shall be taxable only in the first-mentioned State if: a) the recipient is present in the other State for a period or periods not exceeding in the aggregate 183 days in any twelve-month period commencing or ending in the tax year concerned, and b) the remuneration is paid by, or on behalf of, an employer who is not a resident of the other State, and c) the remuneration is not borne by a permanent establishment or a fixed base which the employer has in the other State. 3. Notwithstanding the preceding provisions of this Article, remuneration derived in respect of an employment exercised aboard a ship or aircraft operated in international traffic by a resident of a Contracting State, may be taxed in that State.

  • Intercarrier Compensation 5.5.1 Intercarrier compensation for seven (7) or ten (10) digit dialed calls originated by ITC^DeltaCom utilizing Local Switching shall apply as follows: 5.5.2 For calls terminating to a BellSouth End User or to an End User served by BellSouth resold services, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. 5.5.3 For calls terminating to a CLEC where such CLEC is utilizing a BellSouth switch port or port/loop combination to provide service to its End User, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. BellSouth will not charge the terminating CLEC for End Office Switching as set forth in Exhibit A at the terminating end office. 5.5.3.1 For calls terminating to third party carriers, such as CLECs, wireless carriers and independent companies, utilizing their own switches to serve their End Users, ITC^DeltaCom is required to enter into interconnection or traffic exchange agreements with such third parties for the exchange of traffic through BellSouth’s network. If ITC^DeltaCom does not have such an agreement with a third party carrier and BellSouth is charged termination charges by a third party terminating a call originated by ITC^DeltaCom, or if such third party carrier bills BellSouth for terminating such calls, despite the existence of such an agreement, then BellSouth may, at its option: 5.5.3.1.1 pay such charges as billed by the third party carrier and charge End Office Switching as set forth in Exhibit A to ITC^DeltaCom for each such call; or 5.5.3.1.2 pay such charges as billed by the third party carrier and ITC^DeltaCom will reimburse the full amount of such charges within thirty (30) days of BellSouth’s request for reimbursement. 5.5.3.2 Intercarrier compensation for seven (7) or ten (10) digit dialed calls terminating to ITC^DeltaCom utilizing Local Switching shall apply as follows: 5.5.3.2.1 For calls originated by a BellSouth End User or by an End User served by resold BellSouth services, BellSouth shall not charge ITC^DeltaCom for End Office Switching at the terminating end office for use of the network component; therefore, ITC^DeltaCom shall not charge BellSouth intercarrier compensation or any other charges for termination of such calls. 5.5.3.2.2 For calls originated by a CLEC where such CLEC is utilizing a BellSouth switch port or port/loop combination to provide service to its End User, BellSouth shall not charge ITC^DeltaCom for End Office Switching at the terminating end office for use of the network component; therefore, ITC^DeltaCom shall not charge the originating CLEC or BellSouth intercarrier compensation or any other charges for termination of such calls. 5.5.3.2.3 For calls originated by third party carriers, such as CLECs, wireless carriers and independent companies,utilizing their own switches to serve their End Users, ITC^DeltaCom is required to enter into interconnection or traffic exchange agreements with such third parties for the exchange of traffic through BellSouth’s network. ITC^DeltaCom may xxxx the third parties according to such agreements and shall not xxxx BellSouth for the exchange of traffic through BellSouth’s network. 5.5.3.3 Intercarrier compensation shall apply as follows for intralata 1+ dialed calls originated by ITC^DeltaCom utilizing Local Switching where ITC^DeltaCom uses BellSouth’s CIC for its End User’s LPIC: 5.5.3.3.1 For calls terminating to a BellSouth End User or to an End User served by BellSouth resold services, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. 5.5.3.3.2 For calls terminating to a CLEC where such CLEC is utilizing a BellSouth switch port or port/loop combination to provide service to its End User, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office. BellSouth will not charge the terminating CLEC for End Office Switching at the terminating end office. In the event that BellSouth is charged termination charges by the CLEC, BellSouth may pay such charges and ITC^DeltaCom will reimburse BellSouth the full amount of such charges within thirty (30) days following BellSouth’s request for reimbursement. 5.5.3.3.3 For calls terminating to third party carriers, such as CLECs, wireless carriers and independent companies, utilizing their own switches to serve their End Users, ITC^DeltaCom is required to enter into interconnection or traffic exchange agreements with such third parties for the exchange of traffic through BellSouth’s network. If ITC^DeltaCom does not have such an agreement with a third party carrier and BellSouth is charged termination charges by a third party terminating a call originated by ITC^DeltaCom, or if such third party carrier bills BellSouth for terminating such calls, despite the existence of such an agreement, then BellSouth may, at its option: 5.5.3.3.3.1 pay such charges as billed by the third party carrier and charge End Office Switching as set forth in Exhibit A to ITC^DeltaCom for each such call; or 5.5.3.3.3.2 pay such charges as billed by the third party carrier and ITC^DeltaCom will reimburse BellSouth the full amount of such charges within thirty (30) days following BellSouth’s request for reimbursement. 5.5.3.4 Intercarrier compensation shall apply as follows for intralata 1+ dialed calls terminating to ITC^DeltaCom utilizing Local Switching where the originating carrier uses BellSouth’s CIC for its End User’s LPIC: 5.5.3.4.1 For calls originated by a BellSouth End User or by an End User served by BellSouth resold service, BellSouth shall charge ITC^DeltaCom for End Office Switching as set forth in Exhibit A at the terminating end office for use of the End Office Switching network component in terminating such calls. ITC^DeltaCom may charge BellSouth for intercarrier compensation at the End Office Switching as set forth in Exhibit A for such calls. ITC^DeltaCom shall not charge originating or terminating switched access rates to BellSouth for termination of such calls. 5.5.3.5 For calls originated by or terminating to interexchange carriers through a switched access arrangement, ITC^DeltaCom may xxxx the interexchange carrier in accordance with ITC^DeltaCom’s tariff and will not xxxx BellSouth any charges for such call. ITC^DeltaCom shall pay BellSouth applicable charges for the use of BellSouth’s network in accordance with the rates set forth in Exhibit A for originating and terminating such calls.

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

  • Compensation for Additional Services Additional Services shall be compensated as set forth on Exhibit A for the stipulated payment amounts set forth therein. Other Additional Services not set forth on Exhibit A that are required or requested by the Owner shall be compensated as agreed, using the methodology set forth on Exhibit A, prior to the Design Professional undertaking such Additional Services; provided, however, that if such compensation cannot be agreed, the Additional Services shall be performed at the hourly rates set forth and listed in Exhibit B, plus reimbursable expenses pursuant to Article 4.1.3 below, with a limitation as to maximum amount specified.

  • COMMERCIAL REUSE OF SERVICES The member or user herein agrees not to replicate, duplicate, copy, trade, sell, resell nor exploit for any commercial reason any part, use of, or access to 's sites.

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