Cost-Shares definition

Cost-Shares. The amount that a Member has to pay when services or drugs are received. It includes any combination of the following three types of payments: (1) any Deductible amount a plan may impose before services or drugs are covered; (2) any fixed Copayment amount that a plan requires when a specific service or drug is received; or (3) any Coinsurance amount, a percentage of the total amount paid for a service or a drug, that a plan requires when a specific service or drug is received. Custodial Care: Care for personal needs rather than Medically Necessary needs. Custodial Care is care that can be provided by people who do not have professional skills or training. This care includes help with walking, dressing, bathing, eating, preparation of special diets, and taking medications. This plan does not cover Custodial Care unless it is provided as a part of daily skilled nursing care or skilled rehabilitation services you are receiving Effective Date: The date when your coverage under this plan begins. If you re-enroll in this plan after a lapse in coverage, the date that the coverage begins again will be your Effective Date. Emergency Care: Covered Services that are: 1) rendered by a Provider qualified to furnish emergency services; and 2) needed to evaluate or stabilize a Member with a condition considered a Medical Emergency. Stabilize means to provide such medical treatment of the Medical Emergency as may be necessary to assure, within reasonable medical probability that no material deterioration of the condition is likely to result from or occur during the transfer of the Member from a Medical Facility. Experimental/Investigational Services: Experimental or Investigational services include a treatment, procedure, equipment, drug, drug usage, medical device or supply that meets one or more of the criteria described below, as determined by us. An Experimental/Investigative service is: Formulary: CHPW’s list of selected Prescription Drugs that are covered under this plan. CHPW established its Formulary and reviews and updates it routinely. Drugs are reviewed and selected for inclusion in CHPW’s Formulary by an outside committee of Providers, including physicians and pharmacists.
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Cost-Shares. In-Network Services Subject to Copays: Copays: Medical Office Visit, $5; Preventive Care Office Visit, $0; Emergency Room, $0; and Per inpatient Admission, $0. Office Visit Maximum: Unlimited. Lifetime Maximum in-Network Benefit: Unlimited. Coinsurance: 80% of the first $4,000 Individual/$8,000 Family worth of Eligible Expenses up to an Annual Out- of-Pocket Expense of $1,000 individual/$2,000 Family. Lifetime Maximum Out-of-Network Benefit: $1,000,000. Pediatric Covered according to an age-based schedule with $0 copay. Covered according to an age-based schedule with $0 copay. Vision Hearing Gynecological Covered once every 2 years with $0 copay. Covered once every 2 years with $0 copay. Covered once every year with $0 copay.
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Examples of Cost-Shares in a sentence

  • HICO (High Cost)Shares with the highest purchase price are the first to be depleted.

  • LOCO (Low Cost)Shares with the lowest purchase price are the first to be depleted.

  • It is the Covered Person’s obligation to pay Cost-Shares as a component of this Maximum Allowable Amount.

  • Hospitalization for Routine Patient Care Costs in connection with Cancer Clinical Trials shall include treatment at an Out-of-Network facility if such treatment is not available In-Network and not eligible for reimbursement by the sponsors of such clinical trial, Out-of Network Hospitalization will be rendered at no greater cost to the insured person than if such treatment was available In-Network, all applicable In-Network Cost-Shares will apply.

  • Cost-Shares (turnouts, crossings, drain relos, tree removal, machine leveling, gated pipe, etc.)The EID will cost-share the project up to a maximum amount, as per policy.

  • NYSERDA will issue a single PO with a maximum incentive of $155,000 to include as follows per site: For RTEM System Installations:• NYSERDA System Installation Cost-Shares are provided per TABLE 1.

  • When applicable, it is the Covered Person’s obligation to pay Cost-Shares as a component of this Maximum Allowable Amount.

  • For RTEM Services (1-5 years eligible):• NYSERDA Service Cost-Shares are provided per TABLE 1.

  • Effective for Plan renewals or new Plans on or after September 23, 2010, some Participating Provider preventive and wellness services, as defined by the United States Preventive Service Task Force and that are listed in your Benefit Summary, are exempt from all Member Cost-Shares (Deductible, Copayment and Coinsurance) under the Patient Protection and Affordable Care Act (PPACA).

  • When applicable, it is the CoveredPerson’s obligation to pay Cost-Shares as a component of this Maximum Allowable Amount.

Related to Cost-Shares

  • Net Shares has the meaning provided in Section 2.12 hereof.

  • Interest Shares means the shares of Common Stock and the related Preferred Share Purchase Rights issuable in payment of interest on the Note.

  • Adjustment Shares shall have the meaning set forth in Section 11(a)(ii) hereof.

  • Coop Shares Shares issued by a Cooperative Corporation.

  • Earnout Shares has the meaning set forth in Section 3.6(a).

  • Earn-Out Shares has the meaning provided in Section 2.2(b).

  • VMTP Shares has the meaning set forth in the preamble to this Agreement.

  • Pre-Funded Warrant Shares means the shares of Common Stock issuable upon exercise of the Pre-Funded Warrants.

  • Unit Shares has the meaning ascribed thereto in the first paragraph of this Agreement;

  • Minimum Purchase Price has the meaning set forth in Section 2.04.

  • Common Warrant Shares means the shares of Common Stock issuable upon exercise of the Common Warrants.

  • Dividend Shares means any shares of Common Stock issuable in lieu of cash dividends paid or to be paid on the Series A Preferred.

  • Consideration Shares has the meaning ascribed thereto in Section 2.2.

  • Shares means the shares of Common Stock issued or issuable to each Purchaser pursuant to this Agreement.

  • Prefunded Warrant Shares means the shares of Common Stock issuable upon exercise of the Prefunded Warrants.

  • Warrant Shares means the shares of Common Stock issuable upon exercise of the Warrants.

  • Conversion Shares means, collectively, the shares of Common Stock issuable upon conversion of the shares of Preferred Stock in accordance with the terms hereof.

  • Trust Shares has the meaning ascribed thereto in Section 2.2.

  • Number of Option Shares means shares of Stock, as adjusted from time to time pursuant to Section 9.

  • PIPE Shares shall have the meaning given in the Recitals hereto.

  • Common Shares means the common shares in the capital of the Corporation;

  • Maximum Purchase Price has the meaning assigned to the term in the Pricing Side Letter.

  • Series D Shares means shares of Series D Convertible Preferred Stock, par value $0.001 per share of the Company and having the rights, privileges, preferences and restrictions set forth in the Charter.

  • Option Shares shall have the meaning ascribed to such term in Section 2.2(a).

  • Other Available Shares means, as of any date, the sum of:

  • Interest Share Amount shall have the meaning set forth in Section 2(a).