Eligible Charge definition

Eligible Charge means any necessary, reasonable, and customary item of which at least a portion is covered under this Plan, but does not include:

Eligible Charge means (a) in the case of a Provider, other than a Professional Provider, which has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide care to participants in the benefit program, or is designated as a Participating Provider by any Blue Cross and/or Blue Shield Plan, at the time Covered Services are rendered, such Provider’s Claim Charge for Covered Services and (b) in the case of a Provider, other than a Professional Provider, which does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide care to participants in the benefit program, or is not designated as a Participating Provider by any Blue Cross and/or Blue Shield Plan, at the time Covered Services are rendered, the following amount (unless otherwise required by applicable law or arrangement with the Non- Participating Provider):

Eligible Charge means the treating health care provider's usual, customary and reasonable charge or the upper limit of the medical fee schedule as found in N.J.A.C. 11:3-29.6, whichever is lower.

Examples of Eligible Charge in a sentence

• Benefits for routine mammograms when rendered by a Participating Provider will be provided at 100% of the Eligible Charge or Maximum Allowance whether or not you have met your program deductible.

• Notwithstanding the preceding sentence, the non‐contracting Eligible Charge for Coordinated Home Care Program Covered Services will be 50% of the Non‐Participating or Non‐Plan Provider's standard billed charge for such Covered Services.

• Except as otherwise provided in this section, the non‐con- tracting Eligible Charge is developed from base Medicare reimbursements and represents approximately 100% of the base Medicare reimbursement rate and will exclude any Medicare ad- justment(s) which is/are based on information on the Claim.

• The penalty does not count toward any out-of-pocket amount.▪ Timeliness of Claim: Benefits are conditioned upon submission of Non-Dental Claims no later than 24 months following the date the Eligible Charge is incurred.

• The Eligible Charge will not include any additional payments that may be permitted under the Medicare laws or regulations which are not directly attributable to a specific Claim, including, but not limited to, disproportionate share payments and graduate medical education payments.

More Definitions of Eligible Charge

Eligible Charge means (a) in the case of a Provider which has a written agreement with the Plan or the entity chosen by the Plan to administer its prescription drug program to provide Covered Services to you at the time you receive the Covered Services, such Provider's Claim Charge for Covered Services and (b) in the case of a Provider which does not have a written agreement with the Plan or the entity chosen by the Plan to provide services to you at the time you receive Covered Services, either of the following charges for Covered Services:

Eligible Charge means (a) in the case of a Provider which has a written agreement with a Blue Cross and Blue Shield Plan or the entity chosen by Blue Cross and Blue Shield to administer its prescription drug program to provide Covered Services to you at the time you receive the Covered Services, such Provider’s Claim Charge for Cov- ered Services and (b) in the case of a Provider which does not have a written agreement with a Blue Cross and Blue Shield Plan or the entity chosen by Blue Cross and Blue Shield to provide services to you at the time you receive Covered Services, either of the following charges for Covered Services:

Eligible Charge means the charge determined by the Trust Fund according to the criteria in Section 3.7 and is the charge used to calculate the benefit payment for a covered service.

Eligible Charge means the lower of Provider’s billed charge or the agreed upon amount for reimbursement that Provider shall receive for Covered Services to Eligible Persons. UHA’s actual payment to Provider shall be less the Eligible Person’s Copayment.

Eligible Charge means any charge against a person on or after January 1, 2027, if the records relating to the charge are eligible to be sealed pursuant to subsection 1 of NRS 179.255 for a drug-related charge that is punishable as a category E felony or a misdemeanor, including, without limitation, a charge pursuant to paragraph (a) of subsection 2 of NRS 453.336, subsection 4 or 5 of NRS 453.336, subsection 2 of NRS 453.3393 or NRS 453.560 or 454.351.

Eligible Charge means any charge against a person on or after January 1, 2027

Eligible Charge means (a) in the case of a Provider, other than a professional Provider, which has a written agreement with Claim Administrator or another Blue Cross and Blue Shield Plan to provide care to Covered Persons, or is designated as a participating Provider by any Blue Cross and Blue Shield Plan, at the time Covered Services for medical benefits are rendered (“Participating Provider”), such Participating Provider’s Claim Charge for Covered Services; and (b) in the case of a Provider, other than a professional Provider, which does not have a written agreement with Claim Administrator or another Blue Cross and Blue Shield Plan to provide care to Covered Persons, or is not designated as a Participating Provider by any Blue Cross and Blue Shield Plan, at the time Covered Services for medical benefits are rendered (“Non- Participating Provider”), the following amount (unless otherwise required by applicable law or arrangement with the Non-Participating Provider):