Eligible Medical Expenses definition

Eligible Medical Expenses or “EME” means the maximum amount SHL will pay for a particular Covered Service as determined by SHL in accordance with SHL’s Reimbursement Schedule.

Eligible Medical Expenses or “EME” means the maximum amount HPN will pay for a particular Covered Service as determined by HPN in accordance with HPN’s Reimbursement Schedule.

Eligible Medical Expenses means those expenses incurred by the Employee, or the Employee’s Spouse or Dependents, after the date of the Employee’s participation in the Health FSA and during the Plan Year to the extent that the expense satisfies the conditions set forth in the Summary Plan Description and are for “medical care” as defined by Code Section 213(d). For purposes of this Plan, the following expenses are not considered “Eligible Medical Expenses” even if they otherwise constitute “medical care” under Code Section 213(d):

Examples of Eligible Medical Expenses in a sentence

• In no event will SHL pay more than SHL’s Eligible Medical Expenses or the Recognized Amount, when applicable, for such services.

• If the Insured receives services other than Emergency Services in a Mental Health or Severe Mental Illness facility without obtaining Prior Authorization from SHL, benefits will be reduced to 50% of what the Insured would have received if the services had been Prior Authorized, provided however, that the benefits paid will not be less than 50% of the Eligible Medical Expenses, or the Recognized Amount when applicable.

• After satisfying any applicable CYD, the Member will pay the applicable tier Copayment and/or Coinsurance plus the difference between the Eligible Medical Expenses, or the Recognized Amount when applicable, of the Generic or Biosimilar Covered Drug and of the Brand Name or Reference Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply.

• Employees and their Dependents shall be entitled to reimbursement for their documented, Eligible Medical Expenses incurred during the Benefit Period.

• Covered Preventive Healthcare Services will be paid at 100% of Eligible Medical Expenses or the Recognized Amount, when applicable, without application of any Calendar Year Deductible, Copayment and/or Coinsurance when such services are provided by a Plan Provider.

More Definitions of Eligible Medical Expenses

Eligible Medical Expenses means those necessitated expenses actually paid by the Insured Person to a Medical Practitioner, physiotherapist, nurse, Hospital and/or ambulance service including expenses for Prescribed Medicine, surgery, nursing treatment, paramedic services and diagnostic tests.

Eligible Medical Expenses means those expenses incurred by the Employee, or the Employee's Spouse or Dependents, after the date of the Employee's participation in the URM and during the Plan Year (plus any applicable grace period extension or carryover option as described in the SPD) to the extent that the expense satisfies the conditions set forth in the Summary Plan Description and are for "medical care" as defined by Code Section 213(d). For purposes of this Plan, the following expenses are not considered "Eligible Medical Expenses" even if they otherwise constitute "medical care" under Code Section 213(d): i) expenses for qualified long term care services (as defined in Code § 7702B(c)); and ii) expenses incurred for health insurance premiums; and iii) over-the-counter drugs and medicines that are not prescribed by a physician. For purposes of this Plan, an expense is "incurred" when the Participant or beneficiary is furnished the medical care or services giving rise to the claimed expense, regardless of when the expense is paid.

Eligible Medical Expenses means an expense paid by the taxpayer for medical care described in Section 213(d) of the Internal Revenue Code;

Eligible Medical Expenses means medically necessary goods or services of a

Eligible Medical Expenses means such expenses as defined in clause 8 of these Guidelines.

Eligible Medical Expenses means those expenses that are eligible for reimbursement under this Health FSA as set forth in the SPD.

Eligible Medical Expenses means those expenses identified eligible under Section 213(d) of the Code. Effective January 1, 2011, Eligible Medical Expenses shall specifically exclude expenses for a medicine or drug unless such medicine or drug is a prescribed drug (determined without regard to whether such drug is available without a prescription) or is insulin.