Allowable benefit definition

Allowable benefit as used in this subsection, means the total charge for a service or supply specified in this Agreement for which benefits will be provided, to the extent that such service or supply is covered by this and/or the Other Contract.
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Allowable benefit means a benefit relating to medical, surgical, or hospital care in the event of
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Allowable benefit means a benefit relating to medical, surgical, or hospital care in the event of sickness, accident, disability, or any combination of sickness, accident, or disability.
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Examples of Allowable benefit in a sentence

  • B) Maximum Allowable Benefit: The maximum annual benefit paid for this type of disability is equal to the smaller of (1) or (2): 1.

  • B) Maximum Allowable Benefit: The maximum annual benefit paid for this type of disability is equal to 2/3rds (66.67%) of your Average Annual Pay, minus any benefits you receive from Social Security.

  • If the provider does not participate in the BCBS Traditional Network or MultiPlan Network, you will be liable for any provider charges in excess of MCTWF ’s Maximum Allowable Benefit in addition to any required in-network level Deductible, Copayment and Coinsurance amounts.

  • If the fees of Out-of-Network providers are greater than the amounts paid under your MCTWF Plan’s Out-of-Network Maximum Allowable Benefit schedule, you will be responsible for paying the balance or the full amount if you have reached your Annual per person maximum.

  • Specific eligibility and participation criteria apply dependant on an employee’s employment status at a point in time, and the Allowable Benefit provided.

  • When the benefits are reduced under the primary plan because a Subscriber does not comply with the plan provisions, or does not maximize benefits available under the primary plan, the amount of such reduction will not be considered an Allowable Benefit.

  • When you use Out-of-Network providers, you are subject to paying any balance over and above the Maximum Allowable Benefit schedule.

  • If the provider does not participate in the BCBS Traditional Network or MultiPlan Network, you may be subject to balance billing for charges in excess of MCTWF’s Maximum Allowable Benefit schedule, in addition to any in-network level Deductible, Copayment and Coinsurance amounts.

  • Benefits will not exceed the Maximum Allowable Benefit for the least expensive service that meets your medical needs.

  • Otherwise, you will be responsible for balances over the Maximum Allowable Benefit and the provider’s charge.


More Definitions of Allowable benefit

Allowable benefit means a benefit to provide medical, surgical, or hospital care or benefits.
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Related to Allowable benefit

  • Allowable Costs means the costs defined as allowable in 42 CFR, Chapter IV, Part 413, as amended to October 1, 2007, except for the purposes of calculating direct medical education costs, where only the reported costs of the interns and residents are allowed. Further, costs are allowable only to the extent that they relate to patient care; are reasonable, ordinary, and necessary; and are not in excess of what a prudent and cost-conscious buyer would pay for the given service or item.

  • Allowable Expense means a necessary, reasonable and customary item of expense for health care, which is:

  • Administrative Expenses means (i) all administrative and operating costs and expenses incurred by the Partnership, (ii) those administrative costs and expenses of the General Partner, including any salaries or other payments to directors, officers or employees of the General Partner, and any accounting and legal expenses of the General Partner, which expenses, the Partners have agreed, are expenses of the Partnership and not the General Partner, and (iii) to the extent not included in clause (ii) above, REIT Expenses; provided, however, that Administrative Expenses shall not include any administrative costs and expenses incurred by the General Partner that are attributable to Properties or partnership interests in a Subsidiary Partnership that are owned by the General Partner directly.

  • Reimbursement Payment shall have the meaning given to that term in Subparagraph 2.02(c).