Common use of PLAN ALLOWANCE Clause in Contracts

PLAN ALLOWANCE. the amount used to determine payment by the Plan for Covered Services provided to a Member and to determine Member liability. Plan Allowance is based on the type of Provider who renders such Services or as required by law. In the case of a Network Provider, the Plan Allowance is the contractual allowance for Covered Services rendered by a Network Provider in a specific geographic region. A Network Provider will accept the Plan Allowance, plus any Member liability, as payment in full for Covered Services. In the case of a Network Dental Provider, the Plan Allowance is expressed in terms of the Maximum Allowable Charge.