Maximum Eligible Expense definition

Maximum Eligible Expense or “MEE” means the maximum amount considered for payment by this Plan for any covered treatment, service, or supply, subject however, to all Plan annual and lifetime maximum benefit limitations. The following criteria will apply to determination of the Maximum Eligible Expense:
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Examples of Maximum Eligible Expense in a sentence

  • Charges therefore do not exceed the Maximum Eligible Expense limits of the Plan.

  • Charges above the Maximum Eligible Expense are the Covered Person’s responsibility and will not apply to the Deductible or annual Out-of-Pocket Maximum.

  • The Plan will pay the Benefit Percentage of the Maximum Eligible Expense indicated.

  • In the case of services other than those described in item (2.) directly above, the Plan will adjust the Maximum Eligible Expense for items and services furnished to a participant by a billing provider that is not a Preferred Provider if the facility where the services are provided is a Preferred Provider.

  • Examples of incidental procedures are: excision of a scar, appendectomy at the time of other abdominal surgery, lysis of adhesions, etc.When an assisting Physician is required to render technical assistance during a Surgical Procedure, the charges for such services will be limited to 25% of the primary surgeon's Maximum Eligible Expense for the Surgical Procedure.

  • Accommodation Provision Accommodation shall be provided for only those Eligible Claim Statements that are not in excess of the Maximum Eligible Expense per Covered Person.

  • If the charge exceeds the Maximum Eligible Expense or the Procedure-Based Limit for the treatment, test service or supply, the excess is not an Eligible Charge.Charges for treatments, tests, services or supplies excluded by this Plan may be reimbursable if such charges are approved by the Plan Administrator before the treatment begins or tests, services or supplies are provided.

  • The Specific Benefit [Annual/Lifetime] Maximum Eligible Expense per Covered Person is changed to: [$1,000,000 - Unlimited], [applicable to [_ ]].

  • When multiple or bilateral Surgical Procedures are performed that increase the time and amount of patient care, Maximum Eligible Expense or Procedure Based Limit will be reduced for each of the lesser procedures.

  • Eligible Expenses will include only the appropriate Maximum Eligible Expense or Procedure Based Limit for those procedures necessary to eliminate oral disease and to replace missing teeth.

Related to Maximum Eligible Expense

  • Eligible Expense means the lesser of the reasonable, customary, usual, fair market value charge for a covered service or the provider's actual charge.

  • Eligible Expenses means expenses incurred for Medical Services rendered with respect to a Disability.

  • Maximum Basic Grant Amount’ has the same meaning as set out in item 1 of Schedule 1 of HESA; ‘National Law’ means (a) for a state or territory other than Western Australia – the Health Practitioner Regulation National Law as set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modification) as a law of the State or Territory; and (b) for Western Australia – the legislation enacted by the Health Regulation National Law (WA) Xxx 0000 that corresponds to the Health Practitioner Regulation National Law;

  • Base Year Value means the assessed value of eligible property January 1 preceding the execution of the agreement plus the agreed upon value of eligible property improvements made after January 1 but before the execution of the agreement.

  • Allowable Expense means a necessary, reasonable and customary item of expense for health care, which is: • covered at least in part under one or more plans covering the person for whom the claim is made; and • incurred while this plan is in force. When a plan provides healthcare coverage in the form of services, the reasonable cash value of each service is considered as both an allowable expense and a benefit paid. Vision care services covered under other plans are not considered an allowable expense under this plan. PLAN means any of the following that provides benefits or services for medical, pharmacy, or dental care treatment. If separate contracts are used to provide coordinated coverage for members of a group, the separate contracts are considered parts of the same plan and there is no COB among those separate contracts.

  • Maximum Distributable Amount means any maximum distributable amount relating to the Issuer and/or the Group (if any) which is determined pursuant to Article 141 of the CRD IV Directive (or, as the case may be, any provision of Danish law transposing or implementing Article 141 of the CRD IV Directive), or any successor provision thereto;

  • Eligible Expenditures means expenditures in respect of the reasonable cost of goods, works and services required for the Project and to be financed out of the proceeds of the Loan allocated from time to time to the eligible Categories in accordance with the provisions of Schedule 1 to this Agreement; and

  • Eligible Expenditure means expenditure in relation to this Project that complies in all respects with the Eligibility Rules.

  • Maximum Benefit Amount means the maximum amount payable for coverage provided to You as shown in the Schedule of Benefits.

  • Maximum allowable cost means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a drug.

  • Annual Deferral Amount means that portion of a Participant's Base Annual Salary and Annual Bonus that a Participant elects to have, and is deferred, in accordance with Article 3, for any one Plan Year. In the event of a Participant's Retirement, Disability (if deferrals cease in accordance with Section 8.1), death or a Termination of Employment prior to the end of a Plan Year, such year's Annual Deferral Amount shall be the actual amount withheld prior to such event.

  • Maximum allowable cost list means a list of drugs for