SHL Reimbursement Schedule definition

SHL Reimbursement Schedule means the schedule showing the amount SHL will pay for Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:  the amount most consistently paid to the Provider; or  the amount paid to other Providers with the same or similar qualifications; or  the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the geographic market, a gap methodology, or Eligible Medical Expense could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of:  the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or  100% of the Eligible Medical Expense for Emergency Services provided by a Non-Plan Provider under your Plan; or  the amount that would be paid for the Emergency Services under Medicare.
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SHL Reimbursement Schedule means the schedule showing the amount SHL will pay Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:
Sample 1Sample 2Sample 3
SHL Reimbursement Schedule means the schedule showing the amount SHL will pay for Eligible Medical Expenses, or the Recognized Amount when applicable, (EME) to Providers and will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on: • the amount most consistently paid to the Provider; or • the amount paid to other Providers with the same or similar qualifications; or • the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the geographic market, a gap methodology, or Eligible Medical Expenses, or the Recognized Amount when applicable, could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of: • the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or • 100% of the Eligible Medical Expenses, or the Recognized Amount when applicable, for Emergency Services provided by a Non-Plan Provider under your Plan; or • the amount that would be paid for the Emergency Services under Medicare.
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Examples of SHL Reimbursement Schedule in a sentence

  • In no event will SHL pay more than the maximum payment allowance established in the SHL Reimbursement Schedule.


More Definitions of SHL Reimbursement Schedule

SHL Reimbursement Schedule means the schedule showing the amount SHL will pay Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non- Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:• the amount most consistently paid to the Provider; or• the amount paid to other Providers with the same or similar qualifications; or• the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the geographic market, a gap methodology, or Eligible Medical Expense could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of:• the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or• 100% of the Eligible Medical Expense for Emergency Services provided by a Non- Plan Provider under your Plan; or• the amount that would be paid for the Emergency Services under Medicare.
Sample 1
SHL Reimbursement Schedule means the schedule showing the amount SHL will pay Eligible Medical Expenses or the Recognized Amount, when applicable, (EME) to Providers. Eligible Medical Expenses or the Recognized Amount, when applicable, will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on: Certificate of Coverage • the amount most consistently paid to the Provider; or • the amount paid to other Providers with the same or similar qualifications; or • the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the geographic market, a gap methodology, or Eligible Medical Expenses or the Recognized Amount, when applicable, could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of: • the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or • 100% of the Eligible Medical Expenses or the Recognized Amount, when applicable, for Emergency Services provided by a Non-Plan Provider under your Plan; or • the amount that would be paid for the Emergency Services under Medicare.
Sample 1
SHL Reimbursement Schedule means the schedule showing the amount SHL will pay Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:  the amount most consistently paid to the Provider; or  the amount paid to other Providers with the same or similar qualifications; or
Sample 1
SHL Reimbursement Schedule means the schedule showing the amount SHL will pay for Eligible Medical Expenses (EME) to Providers. EME will be applicable to Non-Plan Providers including Non-Plan Facilities. SHL Reimbursement Schedule is based on:  the amount most consistently paid to the Provider; or  the amount paid to other Providers with the same or similar qualifications; or  the relative value and worth of the service compared to other services which SHL determines to be similar in complexity and nature with reference to other industry and governmental sources, examples of these sources include published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for Medicare for the same or similar services within the Agreement of Coverage geographic market, a gap methodology, or Eligible Medical Expense could be based on a percentage of the provider’s billed charge. For Non-Plan Provider Emergency Services, SHL will pay the greater of:  the amount we have negotiated with Plan Providers for the Emergency Services received (and if there is more than one amount, the median of the amounts); or  100% of the Eligible Medical Expense for Emergency Services provided by a Non-Plan Provider under your Plan; or  the amount that would be paid for the Emergency Services under Medicare.
Sample 1

Related to SHL Reimbursement Schedule

  • Cost-reimbursement contract means a contract under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms and the provisions of this code, and paid a fee, if any.

  • Payment Schedule ’ means a schedule which sets out—

  • Additional Fees means, where applicable, those fees and charges for the Additional Goods/Services and additional costs and levies required from time to time and notified to you in advance, to provide adequately for the education and related activities and services provided to your Child/the Student, including but not limited to the costs of extra-curricular activities or special educational needs.