for exclusions Clause Samples

for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider.
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for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • the network provider has a Standard or Enhanced benefit designation; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider.
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for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. The following network assignments shall apply to this plan: Network Assignments Important Information Network Provider Services Network providers are those healthcare providers that have entered into a contract to provide covered healthcare services for this plan. If you receive covered healthcare services from a network provider, the provider has agreed to accept our payment for covered healthcare services as payment in full, excluding your copayments, deductible (if any), and the difference between the benefit limit and our allowance. This plan uses the BlueCHiP provider network. Our service area for network providers includes Rhode Island and the counties of Connecticut and Massachusetts that border Rhode Island. Non-network Provider Services Non-network providers are those healthcare providers that have not entered into a contract to provide covered healthcare services for this plan. Services received from a non-network provider are not covered except in the following special circumstances: • emergency care (emergency room, urgent care and ground ambulance services); • air ambulance services; • we specifically approve the use of a non-network provider for covered healthcare services, see Network Authorization in Section 5 for details; Network Assignments Important Information • certain non-emergency covered healthcare services performed by a non-network provider at a network facility as described in Section 5; • otherwise, as required by law. In these special circumstances, the services rendered by a non- network provider will be covered at the network benefit level shown in the Summary of Medical Benefits. The deductible and maximum out-of-pocket expenses are calculated based on the lower of our allowance or the provider’s charge, unless special circumstances apply or otherwi...
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for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a Tier 1 or Tier 2 in-network provider, an out-of-network provider, or a non-participating provider; • the deductible (if any), copayment, or benefit limits applied; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by an in-network provider. All of our payments at the benefit levels noted below are based upon a fee schedule called our
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for exclusions. The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a p h y s i cofificae, nin ’yosur home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • the deductible (if any), copayment, or benefit limits applied; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. All of our payments at the benefit levels noted below are based upon a fee schedule called our
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Related to for exclusions

  • Grounds for exclusion Purely national exclusion grounds: 5 Lot 5.1 Lot technical ID: LOT-0001

  • Requests for Exclusion 9.1 The provisions of this section shall apply to any request by a Class Member for exclusion from the Class. 9.2 Any Class Member may make a request for exclusion by submitting such request in writing as set forth in the Notice. 9.3 Any request for exclusion must be submitted no later than the date specified in the Court’s preliminary approval order. 9.4 Any request for exclusion shall (i) state the Class Member’s full name and current address, (ii) provide the model year and Vehicle Identification Number (“VIN”) of his/her/its Class Vehicle(s) and the approximate date(s) of purchase or lease, and (iii) specifically and clearly state his/her/its desire to be excluded from the Settlement and from the Class. 9.5 Failure to comply with these requirements and to timely submit the request for exclusion will result in the Class Member being bound by the terms of the Settlement Agreement. 9.6 Any Class Member who submits a timely request for exclusion may not file an objection to the Settlement and shall be deemed to have waived any rights or benefits under this Settlement Agreement. 9.7 The Settlement Administrator shall report the names of all Class Members who have submitted a request for exclusion to the Parties on a weekly basis, beginning 30 days after the Notice Date. 9.8 Co-Lead Class Counsel represent and warrant that they have no other agreements with other counsel respecting Class Members, including any agreements with respect to referring, soliciting, or encouraging any Class Members to request to be excluded (or “opt out”) from this agreement. 9.9 Upon certification of the Class in connection with the Preliminary Approval of this agreement, Co-Lead Class Counsel agree to seek in the Preliminary Approval Order from the Court a provision encouraging all written communications to multiple Class Members with respect to this Agreement to be reviewed and approved by Co-Lead Class Counsel and the Court, and Co- Lead Class Counsel agree to abide by that provision as may be required by the Court.

  • Requests for Exclusion (Opt-Outs) 6.5.1. Class Members who wish to exclude themselves (opt-out of) the Class Settlement must send the Administrator, by fax, email, or mail, a signed written Request for Exclusion not later than 45 days after the Administrator mails the Class Notice (plus an additional 14 days for Class Members whose Class Notice is re-mailed). A Request for Exclusion is a letter from a Class Member or his/her representative that reasonably communicates the Class Member’s election to be excluded from the Settlement and includes the Class Member’s name, address and email address or telephone number. To be valid, a Request for Exclusion must be timely faxed, emailed, or postmarked by the Response Deadline. 6.5.2. The Administrator may not reject a Request for Exclusion as invalid because it fails to contain all the information specified in the Class Notice. The Administrator shall accept any Request for Exclusion as valid if the Administrator can reasonably ascertain the identity of the person as a Class Member and the Class Member’s desire to be excluded. The Administrator’s determination shall be final and not appealable or otherwise susceptible to challenge. If the Administrator has reason to question the authenticity of a Request for Exclusion, the Administrator may demand additional proof of the Class Member’s identity. The Administrator’s determination of authenticity shall be final and not appealable or otherwise susceptible to challenge. 6.5.3. Every Class Member who does not submit a timely and valid Request for Exclusion is deemed to be a Participating Class Member under this Agreement, entitled to all benefits and bound by all terms and conditions of the Settlement, including the Participating Class Members’ Releases paragraph of this Agreement, regardless of whether the Participating Class Member actually receives the Class Notice or objects to the Settlement. 6.5.4. Every Class Member who submits a valid and timely Request for Exclusion is a Non-Participating Class Member and shall not receive an Individual Class Payment, nor shall they have the right to object to the class action components of the Settlement.

  • For example If an employee utilises two weeks recreation leave over a period of four weeks at half pay, service based entitlements (e.g. personal leave, long service leave, paid parental leave) will be deferred by two weeks.

  • GENERAL EXCLUSIONS We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects a substantial area.