Member Expenses definition

Member Expenses means copayments, coinsurance, deductibles, or other cost share amounts, if any, that a Member is required to pay for Covered Services under a Benefit Plan.

Member Expenses. Any amount of Customary Charges that are the Member's responsibility to pay Provider in accordance with the terms of the Member's Benefit Plan, including co-payments, co-insurance and deductible amounts. Mental Health and Substance Abuse Services ("MHSA Services"): Health care services, treatment or supplies that are used to treat a mental health or substance abuse illness, condition or disease and which may be eligible for coverage under the Member's Benefit Plan. Participating Provider: A health care professional, facility, CMHC Supervising Provider, psychiatrist, psychologist or other behavioral health professional or Payment Policies: Guidelines adopted by UBH, from time to time, for calculating payment of claims under Benefit Plans. Payor: The entity or person that has the financial responsibility for funding payment of Covered Services on behalf of a Member, and that is authorized to access MHSA Services in accordance with this Agreement. Protocols: The programs, policies, protocols, processes, procedures, and requirements as such may change or be modified from time to time, and that are adopted by UBH or Payor, and which Provider agrees to follow as a condition of UBH accepting Provider as a Participating Provider, including, but not limited to, authorization procedures, credentialing and re-credentialing processes and plans, utilization management and care management processes, billing procedures, Payment Policies, providing or arranging for Emergency Services, quality improvement, peer review, on- site review, Member grievance and appeals processes, and any other policies, procedures, processes, activities or standards, wherever located as may apply to Provider's rights, obligations or responsibilities as a Provider of MHSA Services, whether in this Agreement, Provider Manual, or any other document as made accessible or available to Provider from time to time. Provider Manual: A document or manual, however known or named, such as the Network Manual, containing the administrative policies, procedures and Protocols applicable to Benefit Plans provided, sponsored or administered by UBH or a Payor including, but not limited to, policies and procedures for credentialing, claims, quality improvement, and utilization management to which Provider is obligated.

Member Expenses means copayments, coinsurance, deductibles, or other cost share amounts, if any, that a member is required to pay for Covered Services under a benefit plan.

Examples of Member Expenses in a sentence

• If Health Plan is not the primary payor for Covered Services provided to a Member, then when not prohibited by Laws or Program Requirements, Health Plan’s payment to Provider for such services shall not exceed the compensation in this Agreement less amounts payable by the primary payor or payors, less Member Expenses.

• If payment of an amount sought in a claim is denied or reduced by Health Plan, the Provider shall adjust Member Expenses accordingly.

• This provision (a) shall survive termination or expiration of this Agreement regardless of the cause giving rise to termination or expiration, (b) shall be construed for the benefit of Members, (c) does not prohibit collection of Member Expenses where lawfully permitted or required, and (d) supersedes any oral or written agreement to the contrary now existing or hereafter entered into between a Provider and Members or persons acting on their behalf.

• Subject to the terms and conditions herein, the obligation for payment for Covered Services provided to a Member, less any applicable Member Expenses, is solely that of Payor.

• Other than incidental travel and subsistence expenses which are set out in the Board Member and Sub-Board Member Expenses Scheme and Hospitality Policy no LEP Board Member, including the Chair or Deputy Chair, shall be remunerated for their role.

More Definitions of Member Expenses

Member Expenses means any amounts that are the Member’s responsibility to pay for Covered Services pursuant to the Member’s Benefit Plan, including without limitation co- payments, coinsurance, deductibles, and other cost-share amounts.

Member Expenses has the meaning assigned to it in Section 4.9.

Member Expenses means copayments, coinsurance, deductibles or other cost share amounts, if any, that a member is required to pay for Covered Services under a benefit plan. “Members with Special Health Care Needs” means adults and children who face daily physical, behavioral or environmental challenges that place their health at risk and whose ability to fully function in society is limited.

Member Expenses means any amounts that are the member’s responsibility to pay you in accordance with the member’s benefit plan, including copayments, coinsurance, and deductibles.

Member Expenses are any amounts that are the Member’s responsibility to pay Provider in accordance with Member’s Benefit Contract.

Member Expenses means personal expenses incurred by the Members in connection with the formation of the Company or the consummation of the MidAmerican Merger.

Member Expenses means all expenses incurred by Empower or any of its Members in conjunction with the transactions contemplated by this Agreement, including without limitation expenses incurred for outside legal counsel, independent accountants and financial advisors including, but not limited to, BancBoston Xxxxxxxxx Xxxxxxxx.