Coinsurance Maximum definition

Coinsurance Maximum means a specified dollar amount of Coinsurance Incurred by a Participant, as set forth in the Summary of Benefits, for covered services in a Benefit Period. (Refer to the Summary of Benefits for the period selected by the Plan.)
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Coinsurance Maximum means the maximum dollar amount in the form of Coinsurance that a Member will be required to pay in a given Benefit Period for Covered Services, as set forth on the Schedule of Benefits. The Coinsurance Maximum does not include the following:
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Coinsurance Maximum means the maximum amount to be paid by an Insured as Coinsurance for Covered Services per Calendar Year. Please refer to Attachment A Benefit Schedule, for specific information on how the Coinsurance Maximum for your Plan is determined. The following are not included in the Calendar Year Coinsurance Maximum:  any expenses for reductions 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;  any expenses for Covered Services in excess of the Eligible Medical Expenses; Copayments and Prescription Drug fees;  expenses for services not covered under this Plan; or  expenses in excess of the Calendar Year, lifetime, or per Illness maximum benefit shown in the Attachment A Benefit Schedule.
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Examples of Coinsurance Maximum in a sentence

  • Coinsurance Maximum: The total amount of coinsurance that an individual pays each year before the carrier pays 100% of allowable charges for covered services.

  • Such services count toward the Out-of-pocket Coinsurance Maximum.

  • See page 4.Coinsurance: The Empire Plan pays 80 percent of reasonable and customary charges for covered services after you meet the combined annual deductible.Reasonable and Customary Charge: The lowest of the actual charge, the provider’s usual charge or the usual charge within the same geographic area.Combined Annual Coinsurance Maximum: After the combined annual coinsurance maximum is reached, benefits are paid at 100 percent of reasonable and customary charges for covered services.

  • The calculation of the total Deductible and Coinsurance Maximum Amounts toward the Out-of-Pocket Maximum Amount begins anew on January 1 of each calendar year.

  • A Covered Person with individual coverage, must incur Allowable Charges for Covered Services from Preferred Providers equal to or exceeding the In-Network Individual Policy Coinsurance Maximum specified in the Schedule of Benefits.

  • The difference between the cost of a brand name drug and the cost of a generic drug is not counted towards the annual Coinsurance Maximum.

  • Once a Covered Person has satisfied the Policy Coinsurance Maximum as specified in subsections 5.2.a.i. or ii.

  • Members pay 20% Coinsurance until the Coinsurance Maximum Amount shown on the Schedule of Benefits is met, unless otherwise specified within this Plan.

  • You will not have to pay this $70 copayment if you are treated in the emergency room and it becomes necessary for the hospital to admit you at that time as an inpatient.The network provider from whom you receive covered services is responsible for collecting the copayment from you.Note - Copayments do NOT count toward meeting your non-network coverage deductibles, Basic Medical deductible or Basic Medical Coinsurance Maximum.

  • Blue Cross and Blue Shield of Texas applies the $34 toward Gary's Non-Network Out-of-Pocket Coinsurance Maximum.

Related to Coinsurance Maximum

  • Coinsurance means that you pay a percent of the total cost of the drug each time you fill a prescription.

  • Insurance Amount has the meaning set forth in Section 6.08(c).

  • Insurance score means a number or rating that is derived from an algorithm, computer application, model, or other process that is based in whole or in part on credit information for the purposes of predicting the future insurance loss exposure of a consumer.

  • Insurance Costs means the sums described in paragraph 1.1 of Part 5 of the Schedule;

  • Deductible Amount means, with respect to any Insuring Agreement, the amount set forth under the heading “Deductible Amount” in Item 3 of the Declarations or in any Rider for such Insuring Agreement, applicable to each Single Loss covered by such Insuring Agreement.

  • Deductible has the meaning set forth in Section 11.1(e).

  • Insurance Cost Increase shall not, however, include any premium increases resulting from the nature of the occupancy of any other lessee of the Building. If the parties insert a dollar amount in Paragraph 1.9, such amount shall be considered the "BASE PREMIUM." If a dollar amount has not been inserted in Paragraph 1.9 and if the Building has been previously occupied during the twelve (12) month period immediately preceding the Commencement Date, the "Base Premium" shall be the annual premium applicable to such twelve (12) month period. If the Building was not fully occupied during such twelve (12) month period, the "Base Premium" shall be the lowest annual premium reasonably obtainable for the Required Insurance as of the Commencement Date, assuming the most nominal use possible of the Building. In no event, however, shall Lessee be responsible for any portion of the premium cost attributable to liability insurance coverage in excess of $1,000,000 procured under Paragraph 8.2(b).

  • Insurance Schedule means Schedule 3 attached hereto.

  • Insurance Add-On Amount means the premium charged to the Obligor in the event that the Servicer obtains Force-Placed Insurance pursuant to Section 4.4.

  • Net direct written premiums means direct gross premiums written in this state on insurance policies subject to this chapter, less return premiums and dividends paid or credited to policyholders on such direct business. “Net direct written premiums” does not include premiums on a contract between insurers or reinsurers.

  • 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

  • Daily Maximum Limit means the maximum allowable discharge of a pollutant during a calendar day. Expressed as units of mass, the daily discharge is cumulative mass discharged over the course of the day. Expressed as a concentration, it is the arithmetic average of all measurements taken that day.

  • Premium Rate has the meaning assigned to such term in the Premium Letter.

  • group insurance means insurance, other than creditor’s group insurance and family insurance, whereby the lives of a number of persons are insured severally under a single contract between an insurer and an employer or other person; (“assurance collective”)

  • Bag limit means the maximum number of game animals, game

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

  • Loss Adjustment Expense means costs and expenses incurred by the Company in connection with the investigation, appraisal, adjustment, settlement, litigation, defense or appeal of a specific claim or loss, or alleged loss, including but not limited to:

  • Total maximum daily load or "TMDL" means the sum of the individual wasteload allocations for point sources, load allocations (LAs) for nonpoint sources, natural background loading and a margin of safety. TMDLs can be expressed in terms of either mass per time, toxicity, or other appropriate measure. The TMDL process provides for point versus nonpoint source trade-offs.

  • Write-Down Amount means, for any Collection Period for any 180-day Receivable or Repossessed Receivable, the excess of (a) the Principal Balance plus accrued and unpaid interest of such Receivable as of the last day of the Collection Period during which such Receivable became a 180-day Receivable or Repossessed Receivable, as the case may be, over (b) the estimated realizable value of such Receivable, as determined by the Servicer in accordance with its normal servicing procedures for the related Collection Period, which amount may be adjusted to zero by the Servicer in accordance with its normal servicing procedures if such Receivable has ceased to be a 180-day Receivable as provided in the definition of “180-day Receivable.”

  • Capitalization Reimbursement Amount As to any Distribution Date, the amount of Advances or Servicing Advances that were added to the Stated Principal Balance of the related Mortgage Loans during the prior calendar month and reimbursed to the Master Servicer or Subservicer on or prior to such Distribution Date pursuant to Section 3.10(a)(vii), plus the Capitalization Reimbursement Shortfall Amount remaining unreimbursed from any prior Distribution Date and reimbursed to the Master Servicer or Subservicer on or prior to such Distribution Date.

  • Maximum Daily Limit means the maximum allowable "Daily Concentration" (defined above) when expressed as a concentration (e.g. mg/l), otherwise, it means the maximum allowable "Daily Quantity" as defined above, unless it is expressed as a flow quantity. If expressed as a flow quantity it means "Maximum Daily Flow" as defined in Section 22a-430-3(a) of the RCSA.

  • Loss Adjustment Expenses means all costs and expenses incurred by the Company in the investigation, adjustment and settlement of claims. Loss adjustment expenses include third-party costs as well as the Company’s internal expenses, including salaries and expenses of loss management personnel and certain administrative costs.