Summary of Benefits In-Network Out-of-Network Sample Clauses

Summary of Benefits In-Network Out-of-Network. Hospital Services 90% after deductible 65% after deductible Physician Services Office Visits 90% after deductible 65% after deductible Surgery in office 90% after deductible 65% after deductible Surgery in hospital 90% after deductible 65% after deductible All Other Eligible Services 90% after deductible 65% after deductible Hospice Services Cover under MM 180-day lifetime max Chiropractic Services Limits 15 visits per calendar year Prescription Drug Benefit 90% after deductible* Preventative Care 100% Not Covered *Plan Deductible (Annual) Per Person $300 $600 In-Network Out-of-Network Per Family $500 $1100 Out-of-Pocket Limit * Per Person $800 $2100 Per Family $1300 $3100 *Includes Deductible Emergency Room Fee 100 $100 Miscellaneous Coverage Provisions ● Occupational therapy is included as an eligible expense. ● Preventive diagnostic tests include a waiver of deductibles for routine pap test, mammography, and prostate exams paid at 100%, including the office visit. ● Home health care will be covered for 120 visits per year under major medical coverage. ● The definition of physician will include optometrists. ● Disability extension of benefits will be excluded. ● Deductible carryover benefits shall be eliminated. ● Two (2) members of the bargaining unit who are married to each other will be covered under one (1) family plan and will pay one (1) monthly family premium. ● An optional mail order prescription plan for maintenance drugs will be implemented. ● There will be non-duplication rules for coordinating benefits ● There will be no cross application of deductibles or out of pocket maximums in network or in non-network. *All eligible prescription drugs will be covered at the in-network coinsurance rate.
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Summary of Benefits In-Network Out-of-Network. Hospital Services 90% after deductible 65% after deductible Physician Services Office Visits 90% after deductible 65% after deductible Surgery in office 90% after deductible 65% after deductible Surgery in hospital 90% after deductible 65% after deductible All Other Eligible Services 90% after deductible 65% after deductible Hospice Services Cover under MM 180-day lifetime max Chiropractic Services Limits 15 visits per calendar year Prescription Drug Benefit 90% after deductible* Preventative Care 100% Not Covered *Plan Deductible (Annual) Per Person $300 $600 Per Family $500 $1100 Out-of-Pocket Limit Per Person $500 $1500 Per Family $800 $2500 Emergency Room Fee 100 $100 Miscellaneous Coverage Provisions • Occupational therapy is included as an eligible expense. • Preventive diagnostic tests include a waiver of deductibles for routine pap test, mammography, and prostate exams paid at 100%, including the office visit. • Home health care will be covered for 120 visits per year under major medical coverage. • The definition of physician will include optometrists. • Disability extension of benefits will be excluded. • Deductible carryover benefits shall be eliminated. • Two (2) members of the bargaining unit who are married to each other will be covered under one (1) family plan and will pay one (1) monthly family premium. • An optional mail order prescription plan for maintenance drugs will be implemented. • There will be non-duplication rules for coordinating benefits • There will be no cross application of deductibles or out of pocket maximums in network or in non-network. *All eligible prescription drugs will be covered at the in-network coinsurance rate.
Sample 1

Related to Summary of Benefits In-Network Out-of-Network

  • Conversion of Wholesale Services to Network Elements or Network Elements to Wholesale Services Upon request, BellSouth shall convert a wholesale service, or group of wholesale services, to the equivalent Network Element or Combination that is available to Global Dialtone pursuant to Section 251 of the Act and under this Agreement or convert a Network Element or Combination that is available to Global Dialtone pursuant to Section 251 of the Act and under this Agreement to an equivalent wholesale service or group of wholesale services offered by BellSouth (collectively “Conversion”). BellSouth shall charge the applicable nonrecurring switch-as-is rates for Conversions to specific Network Elements or Combinations found in Exhibit A. BellSouth shall also charge the same nonrecurring switch-as-is rates when converting from Network Elements or Combinations. Any rate change resulting from the Conversion will be effective as of the next billing cycle following BellSouth’s receipt of a complete and accurate Conversion request from Global Dialtone. A Conversion shall be considered termination for purposes of any volume and/or term commitments and/or grandfathered status between Global Dialtone and BellSouth. Any change from a wholesale service/group of wholesale services to a Network Element/Combination, or from a Network Element/Combination to a wholesale service/group of wholesale services, that requires a physical rearrangement will not be considered to be a Conversion for purposes of this Agreement. BellSouth will not require physical rearrangements if the Conversion can be completed through record changes only. Orders for Conversions will be handled in accordance with the guidelines set forth in the Ordering Guidelines and Processes and CLEC Information Packages as referenced in Sections 1.13.1 and 1.13.2 below.

  • Out-of-Network Services We Cover the services of Non-Participating Providers. See the Schedule of Benefits section of this Contract for the Non-Participating Provider services that are Covered. In any case where benefits are limited to a certain number of days or visits, such limits apply in the aggregate to in-network and out-of-network services.

  • NON-NETWORK PROVIDER is a provider that has not entered into a contract with us or any other Blue Cross and Blue Shield plan. For pediatric dental care services, non-network provider is a dentist that has not entered into a contract with us or does not participate in the Dental Coast to Coast Network. For pediatric vision hardware services, a non-network provider is a provider that has not entered into a contract with EyeMed, our vision care service manager.

  • Verizon’s Provision of Network Elements Subject to the conditions set forth in Section 1, in accordance with, but only to the extent required by, Applicable Law, Verizon shall provide PCS access to the following:

  • Special Service networks The following services must be received from special service network providers in order to be covered. All terms and conditions outlined in the Summary of Benefits apply.

  • Use of Verizon Telecommunications Services 2.1 Verizon Telecommunications Services may be purchased by Connectel under this Resale Attachment only for the purpose of resale by Connectel as a Telecommunications Carrier. Verizon Telecommunications Services to be purchased by Connectel for other purposes (including, but not limited to, Connectel’s own use) must be purchased by Connectel pursuant to other applicable Attachments to this Agreement (if any), or separate written agreements, including, but not limited to, applicable Verizon Tariffs.

  • Joint Network Implementation and Grooming Process Upon request of either Party, the Parties shall jointly develop an implementation and grooming process (the “Joint Grooming Process” or “Joint Process”) which may define and detail, inter alia:

  • Unbundled Network Terminating Wire (UNTW) 2.8.3.1 UNTW is unshielded twisted copper wiring that is used to extend circuits from an intra-building network cable terminal or from a building entrance terminal to an individual End User’s point of demarcation. It is the final portion of the Loop that in multi-subscriber configurations represents the point at which the network branches out to serve individual subscribers.

  • Portal-to-Portal All employees shall receive portal to portal mileage reimbursement when on a call back.

  • Out of Network Covered for Medical Base Plan with $600 deductible and 70% coinsurance up to the annual out-of-pocket maximum. Pre-arranged services while outside the area are covered as if in-network.

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