Enrolled Member definition
Examples of Enrolled Member in a sentence
BCBSRI shall protect the personal information pertaining to an Enrolled Member as required by Massachusetts Regulation 201.
Regarding all amounts owed by GROUP as a result of any retroactive adjustment(s), upon billing of GROUP by BCBSRI, GROUP agrees to reimburse all payments or allocations made by BCBSRI on behalf of an Enrolled Member determined not to be eligible to receive Health Care Coverage, following the confirmed date of ineligibility.
Unless subject to a fixed dollar copayment, the calculation of the Enrolled Member liability on claims for covered healthcare services will be based on the lower of the participating provider's billed covered charges or the negotiated price made available to BCBSRI by the Host Blue.
Where a reference benefit limit exceeds either a negotiated price or a provider’s billed charge, the Enrolled Member will incur no additional liability, other than any applicable Enrolled Member cost sharing.
Under this Arrangement, when Enrolled Member access covered healthcare services within the geographic area served by a Host Blue, the Host Blue will be responsible for contracting and handling all interactions with its participating healthcare providers.