Common use of Allowable Charge Clause in Contracts

Allowable Charge. For a charge to be allowable, it must be an Allowed Amount and at least part of it must be covered under this Plan. In the case of an HMO or other in-network-only plans, this Plan will not consider any charges in excess of what the HMO or Network Provider has agreed to accept as payment in full. When an HMO or in-network-only plan is primary and the Covered Person does not use the HMO or Network Provider, this Plan will not consider as an Allowable Charge any charge that would have been covered by the HMO or in-network-only plan had the Covered Person used the services of an HMO or Network Provider. In the case of service type plans where services are provided as benefits, the reasonable cash value of each service will be the Allowable Charge.

Allowable Charge. For a charge to be allowable, it must be an Allowed Amount a Usual Customary and Reasonable Charge and at least part of it must be covered under this Plan. In the case of an HMO or other in-in- network-only plans, this Plan will not consider any charges in excess of what the HMO or Network Provider has agreed to accept as payment in full. When an HMO or in-network-only plan is primary and the Covered Person does not use the HMO or Network Provider, this Plan will not consider as an Allowable Charge any charge that would have been covered by the HMO or in-network-only plan had the Covered Person used the services of an HMO or Network Provider. In the case of service type plans where services are provided as benefits, the reasonable cash value of each service will be the Allowable Charge.