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 Deductible: A specific amount a Member is required to pay for certain Covered Services before benefits are paid under the Agreement. 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: • A drug or device that can’t be lawfully marketed without the approval of the U.S Food and Drug Administration, and hasn’t been granted such approval on the date the service is provided; • A service that is subject to oversight by an Institutional Review Board; • A service for which no reliable evidence demonstrates that the service’s effectiveness in clinical diagnosis, evaluation, management or treatment of the condition; • A service that is the subje...
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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. Out-of-Network Services Subject to Deductible and Coinsurance: Deductible: $200 individual/$400 Family. 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. Adult 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

  • How Cost-Shares Are Calculated Your cost shares for emergency care services or for covered services received by a non-participating provider at a participating provider facility, will be calculated using the median plan a participating provider contract rate that we pay participating providers for the geographic area where the covered service is provided.

  • Notes: Please refer to the Schedule of Benefits for the appropriate Cost-Shares.

  • Prior to the beginning of each season all players must be registered with their Club on MyCricket.

  • Any amounts in excess of maximum allowed amounts or any Medical Benefit Maximum.Waived Cost-Shares Non-Participating Provider.

  • For more information, see CRS Report R41101, FEMA Disaster Cost-Shares: Evolution and Analysis, by Natalie Keegan and Elizabeth M.

  • Note: You may incur additional Cost-Shares when services other than Preventive Care are rendered during a Preventive Care visit.

  • Payment will be made to the Participating Pharmacy by CVS Caremark, except for Co-payments or Cost-Shares that are payable by Member at the Participating Pharmacy.

  • How Cost-Shares Are Calculated Your cost shares for Emergency Services or for Covered Services received by an Out-of-Network Provider at a Network Facility, will be calculated using the median Plan Network contract rate that we pay Network Providers for the geographic area where the Covered Service is provided.

  • How Cost-Shares Are Calculated Your cost shares for emergency care services or for covered services received by a non-participating provider at a participating provider facility, will be calculated using the median benefit program a participating provider contract rate that we pay participating providers for the geographic area where the covered service is provided.

  • Cost-Shares for Construction and Operation of New Corps Projects Project Purpose NavigationCoastal Ports— Maximum Federal Share of Construction Maximum Federal Share of O&M <20 ft.

Related to Cost-Shares

  • Cost Share means the member’s financial obligation for a covered service. Depending on the plan type, cost-share may include one or more of the following: deductible, copay, access fee, coinsurance, pharmacy deductible, and precertification charges.

  • Net Shares means the number of shares of Common Stock which will be deposited in a brokerage account in the Grantee’s name at the Company’s designated broker after shares have been withheld to satisfy applicable tax and withholding requirements upon vesting of the Restricted Stock Units.

  • 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 means the Common Shares comprising part of the Units;

  • 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 the shares of Common Stock issuable in payment of dividends payable on the Preferred Shares in accordance with the terms of the Certificate of Designation.

  • Consideration Shares shall have the meaning set forth in Section 2.7(c).

  • Shares means the interests of Shareholders corresponding to the redeemable securities of record issued by the Fund under the Investment Company Act of 1940 that are held by the Intermediary.

  • 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.

  • 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 Company;

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

  • 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:

  • Payment Shares has the meaning set forth in Section 2.02;

  • Number of Shares As of any date, the product of (i) the Number of Options, (ii) the Conversion Rate and (iii) the Applicable Percentage.

  • Transfer Price has the meaning set forth in Section 2.01.

  • Units means the units of the Company, each comprised of one share of Common Stock and one-half of one Warrant.