Reasonable and Customary Charges. Reasonable and Customary charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury involved
Reasonable and Customary Charges. Reasonable Charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness/injury involved.
Reasonable and Customary Charges. If the Insurer believes the charges for medical treatment actually incurred do not correspond to reasonable and customary charges for such treatment in the country concerned then, at its option, the level of reimbursement may be limited to the medical rates and associated costs, as well as to the length of hospitalisation generally prevailing and of normal standard in the country where the patient is treated. A "Reasonable and Customary Charge" is a charge for a service or supply that is: - the charge made for it by the supplier, or - the prevailing charge in the same area made by those of similar professional standing whichever is the lesser. If a customary charge cannot be established for an unusual service or supply, the Insurer will determine whether the charge is reasonable, considering the complexity involved, the degree of professional skill required, and other pertinent factors. Medical expenses are refunded only against presentation of properly documented bills. Evidence must be given that pharmaceutical medicines were prescribed by a doctor.
Reasonable and Customary Charges. Amount charged for treatment, supplies or medical services medically necessary to treat the Insured Person's condition; does not exceed the usual level of charges for similar treatment, supplies or medical services in the locality where the expense is incurred; and does not include charges that would not have been made if no insurance existed.
Reasonable and Customary Charges. Mean those which are usually made to a person without for the items of expense listed under Eligible Expenses an which do not exceed the general level of charges in the are where the expense is incurred. be insured for the Out-of Province Emergency and Travel Benefit, a member and his insured dependant have provincial health care coverage. Expenses for services and travel assistance benefits are if: They are incurred as a result of emergency treatment of a disease or injury, which occurs outside the member's or dependant's province of residence. They are medically necessary, and They are incurred due to an emergency, which occurs during the first six months of travelling on vacation or business outside the member or dependant's province of residence. The six month travel period starts on the first day of departure. FOR SERVICES expenses mean the reasonable and customary for the following items of expense, less the amount by a government plan. Public xxxx accommodation and auxiliary hospital services in a general hospital. Services of a physician. Economy air fare for the patient's return to his province of residence for medical treatment. Licensed ground ambulance service to the nearest hospital equipped to provide the required treatment, or to Canada, when the patient's physical condition prevents the use of another means of transportation. Emergency air ambulance service to the nearest hospital equipped to provide the required treatment, or to Canada, when the patient's condition prevents the use of another means of transportation, and if the patient requiresa registered nurse during the flight, the services and return air fare for the registered nurse. maximum amount per calendar year for the above Expenses is for the member and for insured dependant. Expenses that are included as Eligible Expenses under Drug, Vision, Hospital or Supplementary Health Care benefits are also eligible while the member is travelling outside of Canada. These expenses are subject to the and reimbursement percentages listed under the appropriate benefit. EXPENSES FOR ASSISTANCE Eligible expenses mean reasonable and customary charges for the following item of expense. Family assistance benefits, which include reimburse- ment for the cost of:
Reasonable and Customary Charges. Reasonable and Customary charges shall mean charges for medical care which is medically necessary shall be considered reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individuals of the same sex and of comparable age, for a similar sickness, disease or injury and in accordance with accepted medical standards and practice could not have been omitted without adversely affecting the Participant’s medical condition.
