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.)
Sample 1Sample 2Sample 3
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: (i) Deductibles; (ii) Copayments; (iii) amounts above a specific Benefit Limit as set forth in the Certificate and/or Schedule of Benefits; (iv) amounts above the Lifetime Benefit Maximum as set forth on the Schedule of Benefits; (v) amounts above the PPO’s Non-Preferred Provider Fee Schedule Amount; and (vi) amounts for non-Covered Services. This means that the Member, not the PPO, will be responsible for payment of all these amounts noted above, even if the Coinsurance Maximum has been reached. As item (v) can result in substantial financial responsibility for the Member, please refer to Exhibit 2 for an illustration of potential Cost Sharing when Non-Preferred Providers are utilized. Amounts paid toward satisfaction of the Coinsurance Maximum amounts for Covered Services obtained from either Preferred or Non-Preferred Providers accrue toward satisfaction of both Coinsurance Maximum amounts as set forth on the Schedule of Benefits. The Coinsurance Maximum applies to each Member or Family Unit subject to any family Coinsurance Maximum set forth on the Schedule of Benefits.
Sample 1Sample 2
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:
Sample 1

Examples of Coinsurance Maximum in a sentence

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

  • If your plan has an in-network Out-of-pocket Coinsurance Maximum, your Coinsurance counts toward this maximum.

  • Copayments under this paragraph are not included in those expenses used to satisfy the Deductibles in paragraph 7A.1.B.1 or the Coinsurance Maximum referenced in paragraph 7A.1.B.4. 7A.2 Covered Medical BenefitsCovered Medical Benefits include the following: A.

  • Copayments for Psychiatric Conditions and substance abuse services do not apply to the Policy Coinsurance Maximum.

  • Allowable Charges incurred for treatment of physical and occupational therapy, Ambulance Services, skilled nursing facility service and home health services may be included in the accumulation of Allowable Charges for the purpose of meeting the Policy Coinsurance Maximum, but payment for such services shall be limited both to the maximum amounts payable and the Coinsurance percentages set forth in Subsections 3.7.3, 3.15 and 3.16, respectively of this Policy.5.3 Other Plans and Benefit Programs.

  • Claims associated with services provided by Preferred Providers may have a more advantageous Deductible, Coinsurance and Policy Coinsurance Maximum than claims for services of Non-Preferred Providers.

  • The Coinsurance Maximum does not include the Deductible amount, non-covered amounts, or charges in excess of Blue Cross Blue Shield of Wyoming’s Allowable Charges.

  • 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.

  • The Maximum Out-of-Pocket Limit applies regardless of whether the Covered Person has met the Medical Benefits Coinsurance Maximum during the Plan Year in any tier.

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 6.12(b).

  • 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.

  • Special Hazard Loss Coverage Amount With respect to the first Distribution Date, $5,000,000. With respect to any Distribution Date after the first Distribution Date, the lesser of (a) the greatest of (i) 1% of the aggregate of the principal balances of the Mortgage Loans, (ii) twice the principal balance of the largest Mortgage Loan and (iii) the aggregate of the principal balances of all Mortgage Loans secured by Mortgaged Properties located in the single California postal zip code area having the highest aggregate principal balance of any such zip code area and (b) the Special Hazard Loss Coverage Amount as of the Closing Date less the amount, if any, of Special Hazard Losses allocated to the Certificates since the Closing Date. All principal balances for the purpose of this definition will be calculated as of the first day of the calendar month preceding the month of such Distribution Date after giving effect to Scheduled Payments on the Mortgage Loans then due, whether or not paid.

  • 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.

  • Fraud Loss Coverage Amount As of the Closing Date, $2,748,787, subject to reduction from time to time, by the amount of Fraud Losses allocated to the Certificates. In addition, on each anniversary of the Cut-off Date, the Fraud Loss Coverage Amount will be reduced as follows:

  • 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 to which this Act applies, less return premiums thereon and dividends paid or credit to policyholders on such direct business. “Net direct written premiums” does not include premiums on contracts 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.

  • group insurance means blanket insurance and franchise insurance and any other forms of group insurance.

  • 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.

  • Insurance Fee Rate With respect to each Mortgage Loan insured by an Insurance Policy paid for by the lender, the per annum rate specified in the Mortgage Loan Schedule.

  • 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.

  • Special Hazard Loss Amount As of any Distribution Date, an amount equal to $5,477,967.00 minus the sum of (i) the aggregate amount of Special Hazard Losses allocated solely to the Class B Certificates in accordance with Section 4.02(a) and (ii) the Special Hazard Adjustment Amount (as defined below) as most recently calculated. For each anniversary of the Cut-Off Date, the Special Hazard Adjustment Amount shall be calculated and shall be equal to the amount, if any, by which the amount calculated in accordance with the preceding sentence (without giving effect to the deduction of the Special Hazard Adjustment Amount for such anniversary) exceeds the greater of (A) the product of the Special Hazard Percentage for such anniversary multiplied by the outstanding principal balance of all the Mortgage Loans on the Distribution Date immediately preceding such anniversary, (B) twice the outstanding principal balance of the Mortgage Loan in the Trust Estate which has the largest outstanding principal balance on the Distribution Date immediately preceding such anniversary and (C) that which is necessary to maintain the original ratings on the Certificates as evidenced by letters to that effect delivered by Rating Agencies to the Master Servicer and the Trust Administrator. On and after the Cross-Over Date, the Special Hazard Loss Amount shall be zero.

  • Cash Value Insurance Contract means an Insurance Contract (other than an indemnity reinsurance contract between two insurance companies) that has a Cash Value greater than $50,000.