Allowable Expense means a necessary, reasonable and customary item of expense for health care, which is: • covered at least in part under one or more plans covering the person for whom the claim is made; and • incurred while this plan is in force. When a plan provides healthcare coverage in the form of services, the reasonable cash value of each service is considered as both an allowable expense and a benefit paid. Vision care services covered under other plans are not considered an allowable expense under this plan. PLAN means any of the following that provides benefits or services for medical, pharmacy, or dental care treatment. If separate contracts are used to provide coordinated coverage for members of a group, the separate contracts are considered parts of the same plan and there is no COB among those separate contracts.
Allowable Expense except as outlined below, means any health care expense including coinsurance or copayments and without reduction for any applicable deductible, that is covered in full or in part by any of the plans covering you. When coordinating benefits as the secondary plan, Delta Dental of Washington must pay an amount which, together with the payment made by the primary plan, cannot be less than the same allowable expense as the secondary Plan would have paid if it was the primary plan. In no event will DDWA be required to pay an amount in excess of its maximum benefit plus accrued savings. When Medicare, Part A, Part B, Part C, or Part D is primary, Medicare’s allowable amount is the allowable expense.
Allowable Expense means a necessary, reasonable and customary item of expense when the item of expense is covered at least in part by one or more Plans covering the Member for whom the claim is made.
Examples of Allowable Expense in a sentence
We will not consider the difference between the cost of a private hospital room and that of a semi- private hospital room as an Allowable Expense unless the stay in a private room is Medically Necessary and Appropriate.
More Definitions of Allowable Expense
Allowable Expense means a medically necessary, reasonable and customary item of expense covered at least in part as an eligible expense or eligible services by:
Allowable Expense means an item of dental expense that is covered at least in part by one or more of the Plans covering the person for whom the claim is made. When a Plan provides benefits in the form of services, the cash value of each procedure provided shall be considered both an Allowable Expense and a Benefit paid.
Allowable Expense means a health care service or expense, including deductibles and copayments, that is covered at least in part by any of the Coverage Plans covering the person. When a Coverage Plan provides benefits in the form of services, (for example an HMO) the reasonable cash value of each service will be considered an Allowable Expense and a benefit paid. An expense or service that is not covered by any of the Coverage Plans is not an Allowable Expense. Dental care, routine vision care, outpatient prescription drugs, and hearing aids are examples of expenses or services that are not Allowable Expenses under the Plan. The following are additional examples of expenses or services that are not Allowable Expenses:
Allowable Expense means any healthcare expense, including coinsurance or copayments, and without reduction for any applicable deductible, that is covered in full or in part by any of the plans covering the person.
Allowable Expense means any healthcare service or expense, including Deductibles or Coinsurance that is covered in full or at least in part by any Plan covering the person.
Allowable Expense as used herein means:
Allowable Expense means all or a portion of any necessary, reasonable, customary, usual, fair market valued item of medical expense incurred by an eligible individual that is deemed to meet the medical necessity definition of the Plan found below and is not excluded or limited by the Plan.