Calendar Year Out of Pocket Maximum means the maximum amount of Out of Pocket expenses a Member is required to pay forCovered Services in a Calendar Year, as outlined in the Attachment A, Schedule of Benefits. Once the Calendar Year Out of Pocket Maximum is met, no further cost share is required for the remainder of the Calendar Year. The Out of Pocket Maximum does not include any amounts: resulting from the Member’s failure to comply with HPN’s Managed Care Program, including the inappropriate use of an emergency room facility for a condition which does not require Emergency Services; in excess of Eligible Medical Expenses; for services that are not Covered Services; for services that are not Prior Authorized through HPN’s Managed Care Program; or in excess of the Calendar Year, per Illness or any other benefit maximums as set forth in Attachment A Benefit Schedule.

Examples of Calendar Year Out of Pocket Maximum in a sentence

Once the Calendar Year Out of Pocket Maximum is met, no further cost share is required for the remainder of the Calendar Year.
We focused on the BGS Administrative Costs as they flow through the true up process, to verify appropriate and consistent reflection of differences appropriately and consistently on a total basis and as divided between the two BGS customer groups of each EDC.
Non-Plan Provider charges may be substantial and do not accrue toward the Calendar Year Out of Pocket Maximum.

More Definitions of Calendar Year Out of Pocket Maximum

Calendar Year Out of Pocket Maximum means the maximum amount of Out of Pocket expenses a Member is required to pay for Covered Services in a Calendar Year, as outlined in the Attachment A, Schedule of Benefits. Once the Calendar Year Out of Pocket Maximum is met, no further cost share is required for the remainder of the Calendar Year. The Out of Pocket Maximum does not include any amounts:  resulting from the Member’s failure to comply with HPN’s Managed Care Program, including the inappropriate use of an emergency room facility for a condition which does not require Emergency Services;  in excess of Eligible Medical Expenses;  for services that are not Covered Services;  for services that are not Prior Authorized through HPN’s Managed Care Program; or  in excess of the Calendar Year, per Illness or any other benefit maximums as set forth in Attachment A Benefit Schedule.

Calendar Year Out of Pocket Maximum means the maximum amount you will pay during a calendar year before AvMed begins to pay 100% of the Allowed Amount or Maximum Allowable Payment for Covered Services during the same calendar year. This limit never includes your Premiums, Prescription Drug Brand Additional Charges, third-party Copayment assistance by a drug manufacturer or any other entity toward your cost-sharing for Covered Services including Specialty Medications, charges in excess of the Maximum Allowable Payment for Covered Services rendered by Out-of-Network Providers, or charges for health care that AvMed does not cover.

Calendar Year Out of Pocket Maximum means the maximum amount of Out of Pocket expenses an Insured is required to pay for Covered Services in a Calendar Year, as outlined in the Attachment A, Schedule of Benefits. Once the Calendar Year Out of Pocket Maximum is met, no further cost share is required for the remainder of the Calendar Year. The Out of Pocket Maximum does not include any expenses:  for reduction in benefits resulting from Insured’s failure to comply with SHL’s Managed Care Program, including the inappropriate use of an emergency room facility for a condition which does not require Emergency Services;  in excess of Eligible Medical Expenses;  for services that are not Covered Services under this Plan; or  in excess of the Calendar Year, per Illness or any other benefit maximums as set forth in Attachment A Benefit Schedule.

Calendar Year Out of Pocket Maximum means the maximum amount of Out of Pocket expenses an Insured is required to pay for Covered Services in a Calendar Year, as outlined in the Attachment A, Schedule of Benefits. Once the Calendar Year Out of Pocket Maximum is met, no further cost share is required for the remainder of the Calendar Year. For purposes of accumulating benefits paid toward any applicable benefit maximums under the Plan, the period of such accumulation will coincide with the time period of the Calendar Year applicable to the Group. The Out of Pocket Maximum does not include any expenses:  for reduction in benefits resulting from Insured’s failure to comply with SHL’s Managed Care Program, including the inappropriate use of an emergency room facility for a condition which does not require Emergency Services;  in excess of Eligible Medical Expenses;  for services that are not Covered Services under this Plan; or  in excess of the Calendar Year, per Illness or any other benefit maximums as set forth in Attachment A Benefit Schedule.

Calendar Year Out of Pocket Maximum means the maximum amount of Out of Pocket expenses a Member is required to pay for Covered Services in a Calendar Year, as outlined in the Attachment A, Schedule of Benefits. Once the Calendar Year Out of Pocket Maximum is met, no further cost share is required for the remainder of the Calendar Year. For purposes of accumulating benefits paid toward any applicable benefit maximums under the Plan, the period of such accumulation will coincide with the time period of the Calendar Year applicable to the Group. The Out of Pocket Maximum does not include any amounts: • resulting from the Member’s failure to comply with HPN’s Managed Care Program, including the inappropriate use of an emergency room facility for a condition which does not require Emergency Services; • in excess of Eligible Medical Expenses; • for services that are not Covered Services; for services that are not Prior Authorized through HPN’s Managed Care Program; or • in excess of the Calendar Year, per Illness or any other benefit maximums as set forth in Attachment A Benefit Schedule.

Calendar Year Out of Pocket Maximum means the maximum amount of Out of Pocket expenses a Member is required to pay for Covered Services in a Calendar Year, as outlined in the Attachment A, Schedule of Benefits. Once the Calendar Year Out of Pocket Maximum is met, no further cost share is required for the remainder of the Calendar Year. The Out of Pocket Maximum does not include any amounts:  resulting from the Member’s failure to comply with HPN’s Managed Care Program, including the inappropriate use of an emergency room facility for a condition which does not require Emergency Services;  in excess of Eligible Medical Expenses, or the Recognized Amount when applicable,;  for services that are not Covered Services;  for services that are not Prior Authorized through HPN’s Managed Care Program; or  in excess of the Calendar Year, per Illness or any other benefit maximums as set forth in Attachment A Benefit Schedule.

Calendar Year Out of Pocket Maximum means the maximum amount of Out of Pocket expenses a Member is required to pay for Covered