Maximum Reimbursable Charge definition

Maximum Reimbursable Charge. The Maximum Reimbursable Charge for covered services is determined based on the lesser of; Medicaid means a state program of medical aid for needy persons established under Title XIX of the Social Security Act of 1965 as amended.
View Source
Maximum Reimbursable Charge means the following as applicable to services eligible under the Plan: Covered Expenses per applicable Plan provisions up to the “Maximum Reimbursable Charge” amount. For professional services billed on a CMS 1500, successor form or other industry standard form, “MRC” is determined based on any of the following:
View Source

Examples of Maximum Reimbursable Charge in a sentence

  • The health care professional may ▇▇▇▇ the customer the difference between the health care professional's normal charge and the Maximum Reimbursable Charge as determined by the benefit plan, in addition to applicable deductibles, co-payments and coinsurance.

  • Plan Coinsurance Plan pays 100% Plan pays 80% Maximum Reimbursable Charge Not Applicable 200% Plan Deductible Individual - Employee Only: $1,500 Family Maximum: $3,000 Individual - Employee Only: $1,500 Family Maximum: $3,000 • The amount you pay for all covered expenses counts toward both your in-network and out-of-network deductibles.

  • Covered Expense for services provided by a Non-Participating Provider will not exceed the lesser of actual billed charges, or a Maximum Reimbursable Charge.

  • Out-of-network non-compliance penalties or charges in excess of Maximum Reimbursable Charge do not contribute towards the out-of-pocket maximum.

  • The health care professional may bill the customer the difference between the health care professional's normal charge and the Maximum Reimbursable Charge as determined by the benefit plan, in addition to applicable deductibles, co-payments and coinsurance.

  • Reimbursement For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge.

  • IN-NETWORK–YOU PAY (Based on Cigna contract allowance) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, COPAYMENTS, ARE THE INSURED PERSON’S RESPONSIBILITY OUT-OF-NETWORK–YOU PAY (Based on Maximum Reimbursable Charge) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, COPAYMENTS, ARE THE INSURED PERSON’S RESPONSIBILITY Medical Benefits NOTE: Treatment in regard to the following will be covered at the plan level for the specific service.

  • Additional information about how we determine the Maximum Reimbursable Charge is available upon request.

  • IN-NETWORK–YOU PAY (Based on Cigna contract allowance) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, ARE THE INSURED PERSON’S RESPONSIBILITY OUT-OF-NETWORK–YOU PAY (Based on Maximum Reimbursable Charge) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, ARE THE INSURED PERSON’S RESPONSIBILITY Coinsurance YOU PAY: YOU PAY: You and Your Family Members pay 50% after the Policy Deductible.

  • IN-NETWORK–YOU PAY (Based on Cigna contract allowance) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, ARE THE INSURED PERSON’S RESPONSIBILITY OUT-OF-NETWORK–YOU PAY (Based on Maximum Reimbursable Charge) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, ARE THE INSURED PERSON’S RESPONSIBILITY Medical Benefits NOTE: Treatment in regard to the following will be covered at the plan level for the specific service.