Total Medical Expenses definition

Total Medical Expenses means the costs, determined by Anthem, that are paid by Anthem during a Measurement Period for all Covered Services (including hospital, medical, pharmacy and non-hospital) provided to the Member Population by all Providers (participating and non-participating, and including Provider and its Primary Care Physicians) furnishing such services to the Member Population, as adjusted by the following factors:
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Total Medical Expenses means the costs incurred by Anthem for payment of all Covered Services (including hospital, medical, pharmacy and non-hospital) provided to each Medicare Advantage Attributed Member by all providers (participating and non-participating, and including Provider and its PCPs) furnishing such services to Medicare Advantage Attributed Members, adjusted by the Stop- Loss Expense and Stop-Loss Credit where appropriate. Total Medical Expenses include:
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Total Medical Expenses means the sum, for a given calendar
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Examples of Total Medical Expenses in a sentence

  • The numerator of an MLR reporting year shall include Total Medical Expenses defined as follows:a.

  • The methodology for the calculation of Materially Higher Health Status Adjusted Total Medical Expenses is set forth in a Technical Bulletin.

  • Attributed to Provider Organizations Total Medical Expenses for all of the payer’s members who are attributed to provider organizations (see Attribution section above).

  • Unattributed Total Medical Expenses for all of the payer’s members who are not attributed to any provider organization.

  • Calculating TME Total Medical Expenses (TME) includes all payments made to provider organizations by payers (both claims-based and non-claims-based), and patient cost sharing.

  • Performance Improvement PlansBeginning in 2016, Performance Improvement Plans (PIPs) will provide a key mechanism under Chapter 224 for the HPC to identify, monitor, and assist payers and providers whose cost growth may threaten the ability of the state to meet the health care cost growth benchmark.Annually, CHIA will provide the HPC a list of payers and providers whose cost growth, as measured by health status-adjusted Total Medical Expenses (TME), is considered excessive and threatens the benchmark.

  • Commercial Total Medical Expenses by Service Category 2013Hospital and physician payments (including non-claims payments) accounted for about three-quarters of all medical expenses.

  • Expenses that enable a family member to further education: (9b) Name of Household Member enabled to further education:Total Disability Expense:Names of Household Members enabled to work: (10) Total Medical Expenses Not Reimbursed by Others:(11) 12.

  • Managing Physician Group Health Status Adjusted Total Medical Expenses 2013The health status of physician groups’ patient panels is a significant driver of changes in expenditures.

  • Total Medical Expenses (18) $625 (Enter amount from Item 11 ONLY if head of household or spouse is at least 62 or disabled.)19.

Related to Total Medical Expenses

  • Medical Expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.

  • Medical Expense means an expense incurred at the time a past member or his or her health reimbursement account dependent is furnished the medical care or service. To be considered a medical expense under this act, the expense shall meet all of the following conditions:

  • Operational Expenses means expenses of the clerk of court used to maintain the clerk's office and includes, but is not limited to, (i) computer support, maintenance, enhancements, upgrades, and replacements and office automation and information technology equipment, including software and conversion services; (ii) preserving, maintaining, and enhancing court records, including, but not limited to, the costs of repairs, maintenance, consulting services, service contracts, redaction of social security numbers from certain records, and system replacements or upgrades; and (iii) improving public access to records maintained by the clerk, including locating technology in an offsite facility for such purposes or for implementation of a disaster recovery plan.

  • local expenditures means expenditures in the currency of the Borrower or for goods or services supplied from the territory of the Borrower; and

  • Travel Expenses means any costs incurred by Licensor associated with the transportation, storage or lodging of equipment, supplies, Licensor employees and other items necessary for business use from Licensor headquarters to Licensee’s facilities. Travel expenses may include, but are not limited to airfare, hotel costs, and meals if applicable. Any travel expenses paid by the Licensee shall be paid at allowable government travel rates consistent with Management Directive 230.10, unless otherwise first approved by the Licensee’s authorized representative.

  • Health care expenses means, for purposes of Section 14, expenses of health maintenance organizations associated with the delivery of health care services, which expenses are analogous to incurred losses of insurers.

  • Program Expenses means all UHC’s expenses of administering the Program under the Indenture and the Act and shall include without limiting the generality of the foregoing; salaries, supplies, utilities, labor, materials, office rent, maintenance, furnishings, equipment, machinery and apparatus, including information processing equipment; software, insurance premiums, credit enhancement fees, legal, accounting, management, consulting and banking services and expenses; Fiduciary Expenses; remarketing fees; Costs of Issuance not paid from proceeds of Bonds; and payments to pension, retirement, health and hospitalization funds; and any other expenses required or permitted to be paid by UHC.

  • Covered Expenses means expenses actually incurred by or on behalf of a Covered Person for treatment, services and supplies covered by the Policy. Coverage under the Participating Organization’s Policy must remain continuously in force from the date of the Covered Accident or Sickness until the date treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date such treatment, service or supply, that gave rise to the expense or the charge, was rendered or obtained.

  • Routine Patient Costs means all health care services that are otherwise covered under the Group Contract for the treatment of cancer or other Life-threatening Condition that is typically covered for a patient who is not enrolled in an Approved Clinical Trial.

  • Development Costs means costs incurred to obtain access to reserves and to provide facilities for extracting, treating, gathering and storing the oil and gas from reserves. More specifically, development costs, including applicable operating costs of support equipment and facilities and other costs of development activities, are costs incurred to:

  • Current Expenses means operating costs other than personal services and shall not

  • Independent expenditure means an expenditure by a person:

  • management expense ratio means the total fees and expenses a fund paid during a year divided by its average assets for that year.

  • Emergency Expenditures means any of the eligible expenditures set forth in the CERC Manual referred to in Section I.F of Schedule 2 to this Agreement and required for the Contingent Emergency Response Part.

  • Allowable Expenses means any necessary, reasonable and customary item of expense at least a portion of which is covered under at least one of the Health Benefit Plans covering the person for whom claim is made. When a Health Benefit Plan provides benefits in the form of coverage for services, the reasonable cash value of each service rendered shall be deemed to be both an Allowable Expense and a benefit paid.