Common use of Member Liability Calculation Clause in Contracts

Member Liability Calculation. When a Member receives Covered Services outside of the MAPD Plan service area from a Medicare Advantage PPO network provider, the cost of the service, on which Member liability (copayment/coinsurance) is based will be either: • The Medicare allowable amount for covered services; or • The amount either Anthem negotiates with the provider or the Host Blue negotiates with its provider on behalf of MAPD Plan Members, if applicable. The amount negotiated may be either higher than, lower than, or equal to the Medicare allowable amount.

Member Liability Calculation. When a Member receives you receive Covered Services outside of the MAPD Plan our service area from a Medicare Advantage PPO network provider, the cost of the service, on which Member member liability (copayment/coinsurance) is based based, will be either: • The Medicare allowable amount for covered services; or • The amount either Anthem negotiates we negotiate with the provider or the Host Blue negotiates with its provider on behalf of MAPD Plan Membersour members, if applicable. The amount negotiated may be either higher than, lower than, or equal to the Medicare allowable amount.