Copayment Maximum definition

Copayment Maximum means the maximum amount of Copayments a Member is required to pay for Covered Services in a Calendar Year in order for full benefits to be payable for Covered Services obtained after the Calendar Year Copayment Maximum is met. For the remainder of the Calendar Year, no further Copayments are required. The Calendar Year Copayment Maximum does not include charges for services that are not Covered Services, services that are not Prior Authorized through the CO-OP’s Care Management Program when required, or charges in excess of the stated Covered Service benefit maximums as set forth in Attachment A Benefit Schedule.
Sample 1Sample 2Sample 3
Copayment Maximum means the maximum amount of Copayments a Member is required to pay for Covered Services in a Calendar Year in order for full benefits to be payable for Covered Services obtained after the Calendar Year Copayment Maximum is met. For the remainder of the Calendar Year, no further Copayments are required. The Calendar Year Copayment Maximum does not include charges for services that are not Covered Services, services that are not Prior Authorized through HPN’s Managed
Sample 1

Examples of Copayment Maximum in a sentence

  • The Copayment Maximum and the Out-of-Pocket Maximum, if applicable, are provided in the Summary of Services and Cost Shares in the EOC.

  • Cost Shares set forth in this Rider do not apply toward the Copayment Maximum set forth in the Summary of Services and Cost Shares in your EOC to which this Rider is attached.

  • The Rx Copayment and Rx Coinsurance set forth above will continue to apply even after the Copayment Maximum in your EOC has been met.

  • If the entire allowance is not used during your initial visit, any unused portion of the allowance cannot be used for the remainder of that calendar year and will not be carried forward to the next calendar year.Your allowance and any payments toward eyewear and services do not count toward the Annual Copayment Maximum.

  • You can also obtain a statement of the amounts that have been applied toward your Copayment Maximum from our Member Services Department.

  • After two or more Members of a Family Unit combined have met the Family Copayment Maximum, the Copayment Maximum will be met for all Members of the Family Unit for the rest of the contract year.

  • If you get services from more than one provider on the same day, more than one copayment may apply.Amount Annual Copayment Maximum DefinitionThe Annual Copayment Maximum is the maximum copayment amount you pay in a calendar year.

  • Hospice outpatient services Individual Member Total Copayment Maximum $JJJJ per Contract Year Membership Unit Total Copayment Maximum $KKKK per Contract Year **Medical treatment required as a result of an emergency, such as a suicide attempt, will be considered a medical expense until the medical condition is stabilized and will not count toward any plan limits that are shown in the Schedule for mental health and substance use disorder services including in-hospital services.

  • After First Dollar 100% coverage is exhausted, the Insured pays all charges for these covered Services until the cal- endar year Copayment Maximum is reached.

  • Service TypeBrief DescriptionYou will owePremium Plan - NetworkNon-Network Exams One per year; 2 per year up to age 18 $10 Copayment $10 Copayment NVA pays up to $45 LensesSingle-vision, bifocal, trifocal, lenticular (see website for other types of lens coverage) $25 copayment $25 Copayment Maximum amount NVA pays varies based on type of lenses.

Related to Copayment Maximum

  • Copayment means that you pay a fixed amount each time you fill a prescription.

  • 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.

  • 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

  • Economic Maximum means the highest incremental MW output level, submitted to PJM market systems by a Market Participant, that a unit can achieve while following economic dispatch.

  • Daily Maximum discharge limitation means the highest allowable “daily discharge” during the calendar month.

  • Premium payment plan means a benefit plan whereby school em- ployees may pay their share of group health plan premiums with pretax dollars as provided in the salary reduction plan under chapter 41.05 RCW pursuant to 26 U.S.C. Sec. 125 or other sections of the Internal Revenue Code.

  • Upper payment limit means the maximum ceiling imposed by

  • Payment Cap For each Mortgage Loan, the percentage limit set forth in the related Mortgage Note concerning the maximum permitted increase in a monthly payment.

  • Daily Maximum Cash Amount means, with respect to the conversion of any Note, the quotient obtained by dividing (A) the Specified Dollar Amount applicable to such conversion by (B) forty (40).

  • Maximum means that the measured value of the quality characteristic or contaminant must not be greater than the release limit stated.

  • Extra Premium means an additional amount charged by Us, as per Our Underwriting Policy, which is determined on the basis of disclosures made by You in the Proposal Form or any other information received by Us including medical examination report of the Life Insured.

  • 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.

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

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

  • Maximum Premium has the meaning set forth in Section 7.06(b).

  • Applicable Share Limit means a number of Shares equal to (A) the minimum number of Shares that could give rise to reporting or registration obligations or other requirements (including obtaining prior approval from any person or entity) of a Dealer Person, or could result in an adverse effect on a Dealer Person, under any Applicable Restriction, as determined by Dealer in its reasonable discretion, minus (B) 1% of the number of Shares outstanding.

  • Maximum allowable cost means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a drug.

  • Payment month means, for all programs except EA, the calendar month for which benefits are issued.

  • Bankruptcy Loss Coverage Amount As of any date of determination, the Bankruptcy Loss Coverage Amount shall equal the Initial Bankruptcy Loss Coverage Amount as reduced by (i) the aggregate amount of Bankruptcy Losses allocated to the Certificates since the Cut-off Date and (ii) any permissible reductions in the Bankruptcy Loss Coverage Amount as evidenced by a letter of each Rating Agency to the Trustee to the effect that any such reduction will not result in a downgrading, qualification or withdrawal of the then current ratings assigned to the Classes of Certificates rated by it.

  • High Deductible Health Plan means a Health Plan as defined by 26 USC § 223(c)(2)(A) that also is a Qualified Health Plan.

  • Premium pay Per the statute, recipients have broad latitude to designate critical infrastructure sectors and make grants to third-party employers for the purpose of providing premium pay or otherwise respond to essential workers. While the interim final rule generally preserves the flexibility in the statute, it does add a requirement that recipients give written justification in the case that premium pay would increase a worker’s annual pay above a certain threshold. To set this threshold, Treasury analyzed data from the Bureau of Labor Statistics to determine a level that would not require further justification for premium pay to the vast majority of essential workers, while requiring higher scrutiny for provision of premium pay to higher- earners who, even without premium pay, would likely have greater personal financial resources to cope with the effects of the pandemic. Treasury believes the threshold in the interim final rule strikes the appropriate balance between preserving flexibility and helping encourage use of these resources to help those in greatest need. The interim final rule also requires that eligible workers have regular in-person interactions or regular physical handling of items that were also handled by others. This requirement will also help encourage use of financial resources for those who have endured the heightened risk of performing essential work.

  • Maximum Loan Amount has the meaning set forth in Section 2.1(a).

  • 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.

  • Premium tax means a tax paid by insurance companies to provincial and territorial governments calculated as a percentage of gross premiums written.

  • Individual PAGA Payment means the Aggrieved Employee’s pro rata share of 25% of the PAGA Penalties calculated according to the number of Workweeks worked during the PAGA Period.

  • Aggregate Limit shall have the meaning assigned to such term in Section 1.1 hereof.