Average Discount Percentage ( definition
Average Discount Percentage (. ADP”)” means a percentage discount determined by the Claim Administrator that will be applied to a Provider’s Eligible Charge for Covered Services rendered to Covered Persons by hospitals and certain other health care facilities for purposes of calculating Coinsurance amounts, deductibles, out-of-pocket maximums and/or any benefit maximums. The ADP will often vary from Claim to Claim. The ADP applicable to a particular Claim for Covered Services is the ADP, current on the date the Covered Service is rendered, that is determined by the Claim Administrator to be relevant to the particular Claim. The ADP reflects the Claim Administrator’s reasonable estimate of average pay- ments, discounts and/or other allowances that will result from its contracts with hospitals and other facilities under circum- stances similar to those involved in the particular Claim, reduced by an amount, not to exceed fifteen percent (15%) of such estimate, to reflect related costs. (See provisions regarding “CLAIM ADMINISTRATOR’S SEPARATE FINAN- CIAL ARRANGEMENTS WITH PROVIDERS” in Exhibit 2 of this Agreement.) In determining the ADP applicable to a particular Claim, the Claim Administrator will take into account differences among hospitals and other facilities, the Claim Administrator’s contracts with hospitals and other facilities, the nature of the Covered Services involved and other relevant factors. The ADP shall not apply to Eligible Charges when the Covered Person’s benefits under the Plan are secon- dary to Medicare and/or coverage under any other group program.
Average Discount Percentage (. ADP”)” means a percentage discount determined by Us that will be applied to an Allowable Amount for Covered Expenses rendered to the Covered Person by Hospitals and certain other health care facilities for purposes of calculating Coinsurance amounts, Deductibles, Out- of- Pocket Maximums and/or benefit maximums. The ADP applicable to a particular Claim for Covered
Average Discount Percentage (. ADP”)” means a percentage discount determined by Us that will be applied to an Allowable Amount for Covered Expenses rendered to the Covered Person by Hospitals and certain other health care facilities for purposes of calculating Coinsurance amounts, Deductibles, Out-of- Pocket Maximums and/or benefit maximums. The ADP applicable to a particular Claim for Covered Expenses is the ADP, current on the date the Covered Expense is incurred, that is determined by Us to be
More Definitions of Average Discount Percentage (
Average Discount Percentage (. (“ADP”) means a percentage discount determined by Claim Administrator that will be applied to a Provider’s Eligible Charge for Covered Services rendered to Covered Persons by Hospitals and certain other health care facilities for purposes of calculating Coinsurance amounts, deductibles, out–of–pocket maximums and/or any benefit maximums. The ADP will often vary from Claim to Claim. The ADP applicable to a particular Claim for Covered Services is the ADP, current on the date the Covered Service is rendered, that is determined by Claim Administrator to be relevant to the particular Claim. The ADP reflects Claim Administrator’s reasonable estimate of average payments, discounts and/or other allowances that will result from its contracts with Hospitals and other facilities under circumstances similar to those involved in the particular Claim, reduced by an amount, not to exceed fifteen percent (15%) of such estimate, to reflect related costs. (See provisions regarding “Claim Administrator’s
Average Discount Percentage (. (“ADP”) means a percentage discount determined by Claim Administrator that will be applied to a Provider’s Eligible Charge for Covered Services rendered to Covered Persons by Hospitals and certain other health care facilities for purposes of calculating Coinsurance amounts, deductibles, out–of–pocket maximums and/or any benefit maximums. The ADP will often vary from Claim to Claim. The ADP applicable to a particular Claim for Covered Services is the ADP, current on the date the Covered Service is rendered, that is determined by Claim Administrator to be relevant to the particular Claim. The ADP reflects Claim Administrator’s reasonable estimate of average payments, discounts and/or other allowances that will result from its contracts with Hospitals and other facilities under circumstances similar to those involved in the particular Claim, reduced by an amount, not to exceed fifteen percent (15%) of such estimate, to reflect related costs. (See provisions regarding “Claim Administrator’s Separate Financial Arrangements with Providers” in Exhibit 3.) In determining the ADP, Claim Administrator will take into account differences among Hospitals and other facilities, Claim Administrator’s contracts with Hospitals and other facilities, the nature of the Covered Services involved and other relevant factors. The ADP shall not apply to Eligible Charges when the Covered Person’s benefits under the Plan are secondary to Medicare and/or coverage under any other group program.