Reimbursement Levels and Coinsurance Sample Clauses

Reimbursement Levels and Coinsurance. Network providers and hospitals shall be prohibited from balance billing, that is, from charging any participant any additional amount other than co-pays, coinsurance or deductibles for covered services. Network Providers shall submit bills and other required paperwork on behalf of the participant. With the exception of certain preventive services which are covered at one hundred percent (100%) and office visits which are covered in full after payment of an office visit co-pay or other specified service, the plan will pay eighty percent (80%) of those covered services performed by network providers. In those instances the participant pays twenty percent (20%) of the plans’ reimbursement rate up to the medical/behavioral health out-of- pocket maximum. Non-network providers may or may not accept the plan’s payment as payment in full. The plan will pay sixty percent (60%) of the contracted allowable amount for non-network providers for covered services. The participant pays forty percent (40%). The non-network provider may xxxx the participant the balance between what is charged and what the plan allows.
Sample 1Sample 2Sample 3See All (6)
AutoNDA by SimpleDocs
Reimbursement Levels and Coinsurance. Network providers and hospitals shall be prohibited from balance billing, that is, from charging any participant any additional amount other than copays, coinsurance or deductibles for covered services. Network Providers shall submit bills and other required paperwork on behalf of the participant. With the exception of certain preventive services which are covered at one hundred percent (100%) and office visits which are covered in full after payment of an office visit copay or other specified service, the plan will pay eighty percent (80%) of those covered services performed by network providers. In those instances, the participant pays twenty percent (20%) of the plans’ reimbursement rate up to the medical/behavioral health out-of- pocket maximum. Except as provided for in Section 55.04 (A), employee co-insurance shall not exceed twenty percent (20%) of the paid charges for covered network services. In health plans which offer to employees the option of using a network or a non-network provider or facility, the plan will pay sixty percent (60%) of the contracted allowable amount for non-network providers for covered services. The participant pays forty percent (40%). The employee coinsurance when using a non-network provider or facility shall not exceed forty percent (40%) of the plan’s contracted allowable amount for non-network providers. Non- network providers may or may not accept the plan’s payment as payment in full. The non-network provider may bill the participant the balance between what is charged and what the plan allows.
Sample 1

Related to Reimbursement Levels and Coinsurance

  • REIMBURSEMENT FOR MILEAGE AND INSURANCE 1. An employee who is required by their employer to use their private vehicle for school district related purposes shall receive reimbursement of: Effective July 1, 2019 $ 0.56 c/Km Effective July 1, 2020 $ 0.57 c/Km Effective July 1, 2021 $ 0.58 c/Km

  • Reimbursement of Travel Expenses If the Servicer provides access to the Review Materials at one of its properties, the Issuer will reimburse the Asset Representations Reviewer for its reasonable travel expenses incurred in connection with the Review on receipt of a detailed invoice.

  • Insurance Reimbursement If you have health insurance, your behavioral health treatments may be covered in whole or in part. The BHCTC will assist you in determining your insurance coverage and will help you fill out any forms needed. Many managed care plans often require an authorization before treatment can begin. You may be required to contact your insurance company to obtain this authorization and/or receive it from your primary care physician. Many managed care plans limit counseling and therapy services to short-term treatment designed to work out specific problems that prevent people from living and working as they normally do. As this is the BHCTC’s model of treatment, this often works out well. Where necessary, we may request more sessions from the managed care plan. In order to do so, we are typically required to complete the insurance company’s forms which may include providing your diagnosis, the reasons you have sought treatment from the BHCTC, the symptoms you are suffering, and how long we believe treatment will or should continue. The information provided will become part of the insurance company’s files. Insurance companies are obligated to keep this information confidential; however, please note that the BHCTC has no control over the handling of this information by the insurance company. If you receive treatment from one of our NJ Licensed Psychologists, your insurance company may request that you authorize the psychologist to disclose certain confidential information in order to obtain insurance coverage benefits for these services. This disclosure can occur only if it is pursuant to a valid authorization and the information is limited to: 1) administrative information (name, age, sex, fees, dates, nature of sessions, etc.); 2) diagnostic information; 3) the status of the patient (voluntary/involuntary; inpatient/outpatient); 4) the reason for continuing psychological services (limited to an assessment of the current level of functioning and the level of distress both rated as mild, moderate, severe or extreme); and 5) a prognosis, limited to the estimated minimal length of treatment. If the Insurance Company has reasonable cause to believe that the psychological treatment in question may not be usual, customary or is unreasonable, it may request an independent review of such treatment by an independent review committee. While a lot can be accomplished in short-term therapy, some people feel they need more services after their insurance benefits end. If this is the case with you, we will discuss what our fees are and the best way for you to arrange payment in order to receive continued treatment. If your insurance company does not allow us to see you after your benefits end, we will be happy to assist you in finding another therapist who will work well with you. It is also important to remember that you always have the right to pay for your treatment yourself to avoid any insurance issues discussed above.

  • Support Coverage We do not provide Production or Development Support for Software that (a) you (or a third party) have modified or recompiled, (b) is running on hardware or hypervisor that is not Supported Hardware or (c) is running in an unsupported Use Case as described in an Exhibit. You are responsible for testing the Software before deploying it in your environment. You should also backup your systems on a regular basis and have those backups available if needed for support purposes.

  • Commercial General Liability and Business Auto Liability will be endorsed to provide primary and non-contributory coverage The Commercial General Liability Additional Insured endorsement will include on-going and completed operations and will be submitted with the

  • Product Coverage This Agreement shall apply to all manufactured products, - including capital goods, processed agricultural products, and those products failing outside the definition of agricultural products as set out in this Agreement. Agricultural products shall be excluded from the CEPT Scheme.

  • Agreement Coverage a. This instrument, and any referenced attachments hereto or documents referred to herein, contains the entire agreement between the parties and any statements, inducements or promises not contained herein shall not be binding upon said parties. This Agreement shall be binding upon the successors in interest of the respective parties.

  • Group Insurance 38.01 The Group Insurance Plan presently in effect shall remain in effect during the term of this Agreement.

  • Tuition Reimbursement Program 21.2.1 The District will fund $28,000 each fiscal year for incentive pay for employees pursuing their National Board Certification, a master’s degree, or an endorsement.

  • Medical Expenses 1. Employees exposed to hazardous physical, biological, or chemical agents shall be provided, at no cost to the employee, with medical examinations or evaluations required by VOSHA regulations. If there are no specific VOSHA regulations or standards for the agent in question, recommendations of the National Institute of Occupational Safety and Health or other generally recognized expert organization shall be used, as determined by the Commissioner of Health.

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