Annual Limitation on Cost Sharing definition

Annual Limitation on Cost Sharing means the amount of Allowance or Allowable Charges a Covered Person must incur for claims in a calendar year before the Covered Person is relieved of the obligation to pay Copayments, Deductible or Coinsurance for the remainder of the calendar year. The Annual Limitation on Cost Sharing is set forth in the Schedule of Benefits.
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Annual Limitation on Cost Sharing means the annual dollar limit on cost sharing required to be paid by an enrollee that is established by a particular QHP. CMS notes that under the EHB/AV rule, the annual limit would not include cost-sharing for benefits provided outside of a QHP’s network, and if a state requires benefits in addition to EHB, the provisions related to cost-sharing reductions do not apply to those additional benefits. In the final rule, CMS clarifies, in response to comments, that in developing silver plan variations, issuers have the flexibility to reduce cost sharing only for in-network services so long as the required AV levels are achieved.
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Annual Limitation on Cost Sharing means the annual dollar limit on cost sharing required to be paid by an enrollee that is established by a particular QHP. CMS notes that under the proposed EHB/AV rule, the annual limit would not include cost-sharing for benefits provide outside of a QHP’s network, and if a state requires benefits in addition to EHB, the provisions related to cost-sharing reductions do not apply to those additional benefits.
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Examples of Annual Limitation on Cost Sharing in a sentence

  • These additional charges may not count toward the In-network Annual Limitation on Cost Sharing.

  • Additional costs, including balance billing, may be incurred for a covered Health Intervention, e.g., anesthesia, radiology, or laboratory tests, provided by a non-PPO Provider in a PPO Hospital unless it meets the exception as provided in Subsection 5.1.7.b. These additional charges may not count toward the In-network Annual Limitation on Cost Sharing.

  • Claims associated with services provided by Out-of-Network Providers may have less advantageous Deductible, Coinsurance and Annual Limitation on Cost Sharing than claims for services of In-Network Providers.

  • Claims associated with services provided by Out-of- Network Providers may have less advantageous Deductible, Coinsurance and Annual Limitation on Cost Sharing than claims for services of In-Network Providers.

  • Once the Deductible is satisfied, a Covered Person is responsible for Coinsurance, which is a percentage of the Allowance or Allowable Charges paid, for claims incurred until the payment equals the Annual Limitation on Cost Sharing specified in the Schedule of Benefits.

  • Annual Limitation on Cost Sharing Section 1302(c)(1) of the Affordable Care Act sets an annual limitation on cost sharing (commonly referred to as a maximum out-of-pocket limit) as part of the EHB package that non- grandfathered policies sold in the individual and small group markets must offer.

  • Copayments count toward the Annual Limitation on Cost Sharing specified in the Schedule of Benefits.

  • For additional information about the annual out-of-pocket limit, see HHS, “Embedded Self-Only Annual Limitation on Cost Sharing FAQs,” May 8, 2015, at https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/ affordable-care-act/for-employers-and-advisers/hhs-guidance-embedded-self-only-annual-limitation-on-cost-sharing- faqs.pdf.

  • After the Annual Limitation on Cost Sharing is satisfied, subject to the provisions of Subsection 5.2.4 of this Benefit Certificate, the Covered Person will have no further responsibility with respect to Allowances or Allowable Charges incurred during the balance of the calendar year.

  • No Allowance or Allowable Charges paid for services or supplies from Non-Preferred Providers shall accumulate to or be impacted by the satisfaction of the Annual Deductible Limitation or the Annual Limitation on Cost Sharing, unless the Company determines that the Non-Preferred Provider should be treated as a Preferred Provider in accordance with one of the provisions listed in Subsection 5.1.3.5.3 Other Plans and Benefit Programs‌1.

Related to Annual Limitation on Cost Sharing

  • Annual Limit means the maximum amount claimable per person in a calendar year, unless otherwise stated.

  • Retirement allowance means the retirement payments to which a member is entitled.

  • Annual Additions means the sum of the following amounts credited to a Participant for a Limitation Year:

  • Tax Limitation Amount means the maximum amount which may be placed as the Appraised Value on the Applicant’s Qualified Property for maintenance and operations tax assessment in each Tax Year of the Tax Limitation Period of this Agreement pursuant to Section 313.054 of the TEXAS TAX CODE.

  • Deduction Limitation means the following described limitation on a benefit that may otherwise be distributable pursuant to the provisions of this Plan. Except as otherwise provided, this limitation shall be applied to all distributions that are “subject to the Deduction Limitation” under this Plan. If an Employer determines in good faith prior to a Change in Control that there is a reasonable likelihood that any compensation paid to a Participant for a taxable year of the Employer would not be deductible by the Employer solely by reason of the limitation under Code section 162(m), then to the extent deemed necessary by the Employer to ensure that the entire amount of any distribution to the Participant pursuant to this Plan prior to the Change in Control is deductible, the Employer may defer all or any portion of a distribution under this Plan. Any amounts deferred pursuant to this limitation shall continue to be credited/debited with additional amounts in accordance with Section 3.7 below, even if such amount is being paid out in installments. The amounts so deferred and amounts credited thereon shall be distributed to the Participant or his or her Beneficiary (in the event of the Participant’s death) at the earliest possible date, as determined by the Employer in good faith, on which the deductibility of compensation paid or payable to the Participant for the taxable year of the Employer during which the distribution is made will not be limited by Code section 162(m), or if earlier, the effective date of a Change in Control. Notwithstanding anything to the contrary in this Plan, the Deduction Limitation shall not apply to any distributions made after a Change in Control.

  • Excess Compensation means Compensation in excess of the following Integration Level: (Choose (1) or (2))

  • Annual Addition The sum of the following amounts allocated on behalf of a Participant for a Limitation Year, of (i) all Employer contributions; (ii) all forfeitures; and (iii) all Employee contributions. Except to the extent provided in Treasury regulations, Annual Additions include excess contributions described in Code Section 401(k), excess aggregate contributions described in Code Section 401(m) and excess deferrals described in Code Section 402(g), irrespective of whether the plan distributes or forfeits such excess amounts. Annual Additions also include Excess Amounts reapplied to reduce Employer contributions under Section 3.10. Amounts allocated after March 31, 1984, to an individual medical account (as defined in Code Section 415(l)(2)) included as part of a defined benefit plan maintained by the Employer are Annual Additions. Furthermore, Annual Additions include contributions paid or accrued after December 31, 1985, for taxable years ending after December 31, 1985, attributable to post-retirement medical benefits allocated to the separate account of a key employee (as defined in Code Section 419A(d)(3)) under a welfare benefit fund (as defined in Code Section 419(e)) maintained by the Employer.

  • SO2 Allowance means “allowance” as defined at 42 U.S.C. § 7651a(3): “an authorization, allocated to an affected unit by the Administrator of EPA under Subchapter IV of the Act, to emit, during or after a specified calendar year, one ton of sulfur dioxide.”

  • Annual limit on intake or "ALI" means the derived limit for the amount of radioactive material taken into the body of an adult worker by inhalation or ingestion in a year. ALI is the smaller value of intake of a given radionuclide in a year by the reference man that would result in a committed effective dose equivalent of 0.05 sievert (five rem) or a committed dose equivalent of 0.5 sievert (fifty rem) to any individual organ or tissue. ALI values for intake by ingestion and by inhalation of selected radionuclides are given in appendix C to rule 3701:1-38-12 of the Administrative Code.

  • Maximum Benefit Amount means the maximum amount payable for coverage provided to You as shown in the Schedule of Benefits.

  • Compensation Limit means the compensation limit of Section 401(a)(17) of the Code, as adjusted under Section 401(a)(17)(B) of the Code for increases in the cost of living.

  • Loss Allocation Limitation As defined in Section 4.4(g).

  • Preferred Allowance means the amount a Preferred Provider will accept as payment in full for Covered Medical Expenses.

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

  • Annual Benefit Limit means the maximum amount of benefits paid by the Company to the Policy Holder in a Policy Year irrespective of whether any limits of any benefit items stated in the Benefit Schedule have been reached. The Annual Benefit Limit is counted afresh in a new Policy Year.

  • Section 415 Compensation means:

  • Tax Limitation Period means the Tax Years for which the Applicant’s Qualified Property is subject to the Tax Limitation Amount and as further identified in Section 2.3.D of this Agreement.

  • 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).

  • NOx Allowance means an authorization to emit a specified amount of NOx that is allocated or issued under an emissions trading or marketable permit program of any kind that has been established under the Clean Air Act or a state implementation plan.

  • Statutory maximum sentence means the maximum length of

  • Disability allowance means monthly payments during

  • emission allowance means a financial instrument as defined in point (11) of Section C of Annex I of Directive [new MiFID].

  • Employee Contributions are contributions made by a Participant on an after-tax basis, whether voluntary or mandatory, and designated, at the time of contribution, as an employee (or nondeductible) contribution. Elective deferrals and deferral contributions are not employee contributions. Participant nondeductible contributions, made pursuant to Section 4.01 of the Plan, are employee contributions.

  • Utility Allowance means a monthly allowance, as provided by the local public housing authority or as otherwise allowed by HUD rules and the GLO rules, for utilities and services (excluding telephone services) to be paid by the tenant. Contextual Note: Unless the context clearly indicates otherwise, an above definition for a singular term shall also apply (where appropriate) to the plural form of such term and vice versa to the extent necessary for giving the proper meanings to the terms defined in this Article II and/or terms otherwise used in this Agreement.

  • Maximum Limit means that number of issued Shares representing 10% of the total number of issued Shares as at the date of the passing of this Resolution (excluding any Shares which are held as treasury shares as at that date); and

  • Lifetime Benefit Limit means the maximum amount of benefits paid by the Company to the Policy Holder cumulatively since the inception of these Terms and Benefits, irrespective whether any limits of any benefit items stated in the Benefit Schedule have been reached or whether the Annual Benefit Limit in a Policy Year has been reached.