Allowed Benefit definition

Allowed Benefit means: SAMPLE
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Allowed Benefit means: For a Preferred Provider, the Allowed Benefit for a Covered Service is the amount agreed upon between CareFirst and the Preferred Provider which, in some cases, will be a rate set by a regulatory agency. The benefit is payable to the provider and is accepted as payment in full, except for any applicable Deductible, Copayment, and Coinsurance amounts, for which the Member is responsible. For a Non-Preferred Practitioner, the Allowed Benefit for a Covered Service is determined in the same manner as the Allowed Benefit for a Preferred Provider. The benefit is payable to the Member or to the provider, at the discretion of CareFirst. The Member is responsible for any applicable Deductible, Copayment, and Coinsurance amounts and for the difference between the Allowed Benefit and the Practitioner's actual charge. It is the Member's responsibility to apply any CareFirst payments to the Health Care Provider's charges. For a Non-Preferred Facility, the Allowed Benefit for a Covered Service is based upon the lower of the provider's actual charge or the established fee schedule if one has been established for that type of Eligible Provider and service, except for facilities that are paid in accordance with Diagnosis Related Groups ("DRG's"). If a fee schedule for the type of Eligible Provider and service has not been established, the Allowed Benefit will be based on facility reimbursement methodology. In some cases, and on an individual basis, CareFirst is able to negotiate a lower rate with an Eligible Provider. In that instance, the CareFirst payment will be based on the negotiated fee and the provider agrees to accept the amount as payment in full except for any applicable Deductible, Copayment, and Coinsurance amounts, for which the Member is responsible. The benefit is payable to the Member or to the facility, at the discretion of CareFirst. The Member is responsible for any applicable Deductible, Copayment, and Coinsurance amounts and, unless negotiated, for the difference between the Allowed Benefit and the Practitioners' actual charge. It is the Member's responsibility to apply any CareFirst payments to the claim from the Non-Preferred Facility. Ancillary Services means facility services that may be rendered on an inpatient and/or outpatient basis. These services include, but are not limited to, diagnostic and therapeutic services such as laboratory radiology, operating room services, incremental nursing services, blood administrative and handling, phar...
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Allowed Benefit means: For a Preferred Provider: The Allowed Benefit for a Covered Service is the lesser of the actual charge which, in some cases, will be a rate set by a regulatory agency, or the amount CareFirst allows for the service in effect on the date that the service is rendered, except for facilities that are paid in accordance with Diagnosis Related Groups ("DRG's"). The benefit is payable to the provider and is accepted as payment in full, except for any applicable Deductible, Copayment or Coinsurance amounts stated in the Schedule of Benefits. For a Non-Preferred Provider that is a health care practitioner:
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Examples of Allowed Benefit in a sentence

  • The Member is responsible for any applicable Deductible, Copayment, or Coinsurance amounts stated in the Schedule of Benefits and the difference between the Allowed Benefit and the practitioner’s actual charge.

  • The Member is responsible for any applicable Deductible, Copayment, or Coinsurance amounts stated in the Schedule of Benefits and, unless negotiated, for the difference between the Allowed Benefit and the provider’s actual charge.

  • The family out-of-pocket maximum must be met before the services for all remaining family members will be covered at 100% up to the Allowed Benefit.

  • It is important to refer to the Schedule of Benefits to determine the percentage of the Allowed Benefit that CareFirst will pay and any specific limits on the number of services that will be covered.

  • The Member is responsible for any applicable Deductible, Copayment, or Coinsurance amounts stated in the Schedule of Benefits and the difference between the Allowed Benefit and the provider’s actual charge.

  • Members may be responsible for balances above the Allowed Benefit.

  • If the Member resides in an area that does not have adequate access to a Contracting Vision Provider and the Member receives Vision Care from a Non-Contracting Vision Provider, the Vision Care Designee will pay up to 100% of the Allowed Benefit.

  • Members will be entitled to reimbursement from CareFirst BlueChoice or its designee in the amount of the Allowed Benefit, minus any applicable Deductible, Copayment, or Coinsurance.

  • For a Non-Contracting Provider that is a health care facility, the Allowed Benefit for a Covered Service is based upon either the provider’s actual charge or the established fee schedule.

  • For a Non-Contracting Provider that is a health care practitioner, the Allowed Benefit for a Covered Service is based upon the lesser of the provider’s actual charge or the established fee schedule.


More Definitions of Allowed Benefit

Allowed Benefit means the maximum amount payable by the plan for Covered Services received by a Member. Members are responsible for payment of their portion of the Allowed Benefit as set forth in the Schedule of Benefits, including any applicable Copayment amount or Coinsurance percentage.
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Allowed Benefit means: Sample
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Related to Allowed Benefit

  • Accrued Benefit means the amount standing in a Participant's Account(s) as of any date derived from both Employer contributions and Employee contributions, if any.

  • Vested Benefits means amounts that are vested or that Executive is otherwise entitled to receive, without the performance by Executive of further services or the resolution of a contingency, under the terms of or in accordance with any investment and savings plan or retirement plan (including any plan providing retiree medical benefits) of the Company or its affiliates, and any ERPs or ESPs related thereto, and any deferred compensation or employee stock purchase plan or similar plan or program of the Company or its affiliates.

  • Plan Benefit means the benefit payable to a Participant as calculated in Article V.

  • Covered benefits or “benefits” means those health care services to which a covered person is entitled under the terms of a health benefit plan.

  • Retirement Benefit means the benefit set forth in Article 5.

  • Net Benefit means the present value of the Covered Payments net of all federal, state, local, foreign income, employment and excise taxes.

  • Death Benefit means the insurance amount payable under the Certificate at death of the Insured, subject to all Certificate provisions dealing with changes in the amount of insurance and reductions or termination for age or retirement. It does not include any amount that is only payable in the event of Accidental Death.

  • Surviving Spouse means the widow or widower, as the case may be, of a Deceased Participant or a Deceased Beneficiary (as applicable).

  • Net death benefit means the amount of the life insurance policy or certificate to be settled less any outstanding debts or liens.

  • Designated Beneficiary means the beneficiary or beneficiaries the Participant designates, in a manner the Administrator determines, to receive amounts due or exercise the Participant’s rights if the Participant dies or becomes incapacitated. Without a Participant’s effective designation, “Designated Beneficiary” will mean the Participant’s estate.

  • Accrued Benefits shall include the following amounts, payable as described herein: (i) all base salary for the time period ending with the Termination Date; (ii) reimbursement for any and all monies advanced in connection with the Executive's employment for reasonable and necessary expenses incurred by the Executive on behalf of the Company and its Affiliates for the time period ending with the Termination Date; (iii) any and all other cash earned through the Termination Date and deferred at the election of the Executive or pursuant to any deferred compensation plan then in effect; (iv) notwithstanding any provision of any bonus or incentive compensation plan applicable to the Executive, a lump sum amount, in cash, equal to the sum of (A) any bonus or incentive compensation that has been allocated or awarded to the Executive for a fiscal year or other measuring period under the plan that ends prior to the Termination Date but has not yet been paid (pursuant to Section 5(f) or otherwise) and (B) a pro rata portion to the Termination Date of the aggregate value of all contingent bonus or incentive compensation awards to the Executive for all uncompleted periods under the plan calculated as to each such award as if the Goals with respect to such bonus or incentive compensation award had been attained; and (v) all other payments and benefits to which the Executive (or in the event of the Executive's death, the Executive's surviving spouse or other beneficiary) may be entitled as compensatory fringe benefits or under the terms of any benefit plan of the Employer, including severance payments under the Employer's severance policies and practices in the form most favorable to the Executive that were in effect at any time during the 180-day period prior to the Effective Date. Payment of Accrued Benefits shall be made promptly in accordance with the Employer's prevailing practice with respect to clauses (i) and (ii) or, with respect to clauses (iii), (iv) and (v), pursuant to the terms of the benefit plan or practice establishing such benefits.

  • Retirement Benefits means benefits paid by reference to reaching, or the expectation of reaching, retirement or, where they are supplementary to those benefits and provided on an ancillary basis, in the form of payments on death, disability, or cessation of employment or in the form of support payments or services in case of sickness, indigence or death. In order to facilitate financial security in retirement, these benefits may take the form of payments for life, payments made for a temporary period, a lump sum, or any combination thereof;

  • Supplemental Benefit means the monthly benefit payable to the Executive under this Agreement.

  • Service benefit means the credit toward retirement benefits as determined by the

  • Monthly Benefit means the monthly amount payable by Liberty to you if you are Disabled or Partially Disabled.

  • Normal Retirement Benefit means an annual benefit equal to One Hundred Fifty Thousand Dollars and No/100 ($150,000.00) per year, payable in accordance with the terms of this Agreement. Beginning on the thirteenth month that the Normal Retirement Benefit is paid, and continuing thereafter until paid in full, the Normal Retirement Benefit shall be increased annually by three percent (3%) from the previous year’s Normal Retirement Benefit amount to account for cost of living increases.

  • Maximum Benefit means the maximum benefit amount of each of the benefits covered under this Policy as stated in the Schedule of Benefits.

  • Net Benefits Test means a calculation to determine whether the benefits of a reduction in price resulting from the dispatch of Economic Load Response exceeds the cost to other loads resulting from the billing unit effects of the load reduction, as specified in Operating Agreement, Schedule 1, section 3.3A.4 and the parallel provisions of Tariff, Attachment K-Appendix, section 3.3A.4.

  • Early Retirement Benefit means the retirement benefit payable to a member following early

  • Regular benefits ’ means benefits payable to an individual under this act or under any other state law, including benefits payable to federal civilian employees and to ex-servicemen pursuant to 5 U.S.C. chapter 85, other than extended benefits.

  • Annual Benefit means an annual sum of fifty thousand dollars ($50,000) multiplied by the Applicable Percentage (defined below) and then reduced to the extent required: (i) under the other provisions of this Agreement; (ii) by reason of the lawful order of any regulatory agency or body having jurisdiction over the Employer; and (iii) in order for the Employer to properly comply with any and all applicable state and federal laws, including, but not limited to, income, employment and disability income tax laws (eg., FICA, FUTA, SDI).

  • Termination Benefit means the benefit set forth in Article 7.

  • Pre-Retirement Survivor Benefit means the benefit set forth in Article 6.

  • Severance Benefit means the payment of severance compensation as provided in Article III.

  • Qualified beneficiary means a beneficiary who, on the date the beneficiary's qualification is determined:

  • Account Balance means, with respect to a Participant, an entry on the records of the Employer equal to the sum of (i) the Deferral Account balance, (ii) the Company Contribution Account balance, and (iii) the Company Restoration Matching Account balance. The Account Balance shall be a bookkeeping entry only and shall be utilized solely as a device for the measurement and determination of the amounts to be paid to a Participant, or his or her designated Beneficiary, pursuant to this Plan.