Copayments and Coinsurance Sample Clauses

The "Copayments and Coinsurance" clause defines the portions of healthcare costs that a patient is responsible for paying out-of-pocket, in addition to any premiums. Typically, copayments are fixed amounts paid for specific services, such as a doctor's visit or prescription, while coinsurance represents a percentage of the cost of covered services that the patient must pay after meeting any deductible. This clause clarifies the financial obligations of the insured, ensuring transparency and helping both parties understand how costs are shared between the insurer and the insured.
Copayments and Coinsurance. You may have some responsibility for the cost of Covered Services under this Agreement and the Schedule of Benefits. Your responsibility may come in the form of Copayments and Coinsurance. These should be paid directly to the Provider. If you have Coinsurance responsibility, you will pay your Coinsurance percentage based on the Provider’s discounted or negotiated charges with Health Options, if any.
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Copayments and Coinsurance. You may have some responsibility for the cost of Covered Services under this Agreement and the Schedule of Benefits. Your responsibility may come in the form of Copayments and Coinsurance. These should be paid directly to the Provider. If you have Coinsurance responsibility, you will pay your Coinsurance percentage based on the Provider’s discounted or negotiated charges with Community Health Options, if any. Depending on the services provided in a single appointment it is possible you may be financially responsible for two copays for one date of service or one copay with an additional amount applied to your Deductible/Coinsurance.
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Copayments and Coinsurance. Copayments and coinsurance are the charges you are responsible for paying for certain covered health services. Copayments are usually expressed as flat dollar amounts. Coinsurance, generally expressed as a percentage, is the amount you pay for covered services after you meet the Plan’s annual deductible, if applicable.
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Copayments and Coinsurance. Covered drugs are provided upon payment of the Rx Copayment or Rx Coinsurance per prescription or refill, set forth below: 30 Day Supply Plan Pharmacy Participating Network Pharmacy Mail Delivery Generic Drugs $15 $30 $15 Brand Drugs $30 $50 $30 Specialty Drugs Refer to the applicable Generic and Brand Drugs Cost Share above Refer to the applicable Generic and Brand Drugs Cost Share above Refer to the applicable Generic and Brand Drugs Cost Share above 90-day Supply of Maintenance Medication Mail Delivery Plan Pharmacy and Participating Network Pharmacy Generic Drugs 2 Rx Copayment(s) shown above 2 Rx Copayment(s) shown above Brand Drugs 2 Rx Copayment(s) shown above 2 Rx Copayment(s) shown above Specialty Drugs 2 Rx Copayment(s) shown above 2 Rx Copayment(s) shown above Weight management drugs for 50% of the Allowable Charge Drugs for the treatment of infertility for 50% of the Allowable Charge. Drugs for the treatment of sexual dysfunction, limited to 8 doses per month, for 50% of the Allowable Charge. Tobacco Cessation drugs for 50% of the Allowable Charge. Oral Chemotherapy Drugs for no charge. If the cost share for the prescription drug is greater than the Allowable Charge for the prescription drug, the Member will only be responsible for the Allowable Charge for the prescription drug.
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Copayments and Coinsurance. Non-Emergency or Non-Urgent Care obtained in an Emergency Room or Urgent Care Center SELECT 2 SELECT 3 Note
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Copayments and Coinsurance. You may have some responsibility for the cost of Covere d Services under this Agreement and the Schedule of Benefits . Your responsibility may come in the form of Copayments and Coinsurance. These should be paid directly to the Provider. If you have Coinsurance responsibility, you will pay your Coinsurance pe Depending on the services provided in a single appointment it is possible you may be financially responsible for two copays for one date of service or one copay with an additional amount applied to your Deductible/ Coinsurance.
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Copayments and Coinsurance. After You meet any applicable Deductible, You are responsible for paying the following Copayment and/or Coinsurance amounts (at the time of purchase, if the Pharmacy submits the claim electronically). (See below for information on claims that are not submitted electronically and for information on maximum quantities.) $20 for each Brand-Name Medication on the Formulary $40 for each Brand-Name Medication not on the Formulary $40 for each Brand-Name Medication on the Formulary $80 for each Brand-Name Medication not on the Formulary Any removal of a Prescription Medication from Our Formulary will be posted at ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇ thirty days prior to the effective date of that change unless the removal is done on an emergency basis or if an equivalent Generic Medication becomes available without prior notice. In the case of an emergency removal, the change will be posted as soon as practicable. If You are taking a Prescription Medication while it is removed from the Formulary and its removal was not due to the Prescription Medication being removed from the market, becoming available over-the-counter, or issuance of a black box warning by the Federal Drug Administration, We will continue to cover Your Prescription Medication for the time period required to use Our substitution process to request continuation of coverage for the removed Prescription Medication and receive a decision through that process, unless patient safety requires an expedited replacement. For information regarding Our substitution process please visit Our pharmacy services Web site at ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇ or ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇ or by contacting Customer Service at 1 (888) 367-2116. Your Copayments and/or any Coinsurance for Prescription Medications obtained from a Participating Pharmacy will be waived during the remainder of a Calendar Year once Your Maximum Coinsurance amount is met. The Deductible (if applicable) does not apply toward the Maximum Coinsurance. In order for the Copayment and/or any Coinsurance to be waived, You must present Your Member card to the Participating Pharmacy at the time of purchase and the Participating Pharmacy must submit the claim electronically. Copayments and/or any Coinsurance You pay to Participating and Nonparticipating Pharmacies as well as to Mail-Order Suppliers count toward the Maximum Coinsurance. Any additional charges, such as costs in excess of the Covered Prescription Medication Expense charged by a Nonparticipating Pharmacy, do not count toward the Ma...
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Related to Copayments and Coinsurance

  • Coinsurance After the deductible is satisfied, seventy percent (70%) coverage up to the plan out-of-pocket maximum designated below.

  • Copayments Effective January 1, 2019, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist. Diagnostic/Preventive 100% 50% after deductible Fillings 80% after deductible 50% after deductible Endodontics 80% after deductible 50% after deductible Periodontics 80% after deductible 50% after deductible Oral Surgery 80% after deductible 50% after deductible Crowns 80% after deductible 50% after deductible Implants Prosthetics 80% after deductible 80% after deductible 50% after deductible 50% after deductible Prosthetic Repairs 80% after deductible 50% after deductible Orthodontics 80% after deductible 50% after deductible

  • Copayment A fixed amount You pay directly to a Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Cost-Sharing: Amounts You must pay for Covered Services, expressed as Copayments, Deductibles and/or Coinsurance. Cover, Covered or Covered Services: The Medically Necessary services paid for, arranged, or authorized for You by Us under the terms and conditions of this Contract. Deductible: The amount You owe before We begin to pay for Covered Services. The Deductible applies before any Copayments or Coinsurance are applied. The Deductible may not apply to all Covered Services. You may also have a Deductible that applies to a specific Covered Service that You owe before We begin to pay for a particular Covered Service. Dependents: The Subscriber’s Spouse and Children. Emergency Dental Care: Emergency dental treatment required to alleviate pain and suffering caused by dental disease or trauma. Refer to the Pediatric Dental Care and Adult Dental Care sections of this Contract for details.

  • Deductibles and Self-Insurance Retentions Any deductibles or self-insured retentions must be declared to and approved by the City. The City may require the Consultant to provide proof of ability to pay losses and related investigation, claims administration and defense expenses within the deductible or self-insured retention. The deductible or self-insured retention may be satisfied by either the named insured or the City.

  • FDIC Insurance For any deposit accounts you open, the FDIC requires Bank to disclose, and you hereby acknowledge, that deposits held by Evolve Bank & Trust are insured up to $250,000 federal deposit insurance limit, per depositor for each ownership category.