Benefit clause Sample Clauses

Benefit clause. Our contract includes provisions that authorize Green Shield Canada to determine the amount of benefits payable, giving considerationto limited procedures, services or courses of treatment that may be performedto accomplish the desired result. The attending medical and the patient have the option of which procedureto use, although payment for the procedure may be based on the treatment" principle. The Benefit Clause is a financial and not intended as a comment regarding any treatment recommended or performedby a medical Services or supplies received as a result of disease, illness or injury due to: intentionally injury while sane or insane, an act of war, declared or undeclared, participation in a riot or commotion, or committing a criminal offence. Failure to keep a scheduled appointmentwith a licensed medical or dental practitioner. Services or supplies which are cosmetic in nature. The completion of any claim forms andlor insurance reports. Services or suppliesthat do not meet accepted standards of medical, dental or ophthalmic practice, including charges for services or supplies which are experimental in nature. Services or supplies any governmental agency which are obtained without cost by compliance with laws or regulations enacted by a federal, provincial, municipalor other governmental body. Services or supplies normally paid through any provincial government health plan, Workplace Safety Insurance Board, the Devices Program or any other government agency, or which would have been payable under such a plan had proper applicationfor coverage been made, or had proper and timely claims submission been made. Services or supplies that are not recommendedor approved by the attending legally qualified medical or dental practitioner. Services or supplies that you are not obligated to pay for or for which no charge would be made in the absence of benefit coverage. Services or supplies which are legally prohibited by the government from coverage. The replacementof lost, missing or stolen items, or itemswhich are damaged due to negligence. Any eligible service that relates to treatmentof injuries arising out of a motor vehicle accident.

Benefit clause. The ancillary expenses listed in §III, Paragraphs 5, 6 and 7 correspond to the most favorable customary price of comparable premises. The landlord pledges that no additional costs beyond these most favorable customary prices shall be charged. The customary most favorable local price within the meaning of this clause shall be determined by a publically employed, sworn expert assigned by the landlord.