Reasonable and Customary Clause Samples
The "Reasonable and Customary" clause defines the standard by which costs or actions are measured, typically referring to what is considered normal or typical within a particular industry or geographic area. In practice, this clause is often used in insurance or service agreements to limit reimbursements or obligations to amounts that are generally charged or accepted for similar services under similar circumstances. Its core function is to prevent excessive or inflated charges by ensuring that only fair and standard costs are covered, thereby protecting parties from unreasonable financial exposure.
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Reasonable and Customary. CHARGES shall mean charges for medical care which is medically necessary shall be considered reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred, when furnishing like or comparable treatment, services or supplies to individual of the same sex and of comparable age for a similar sickness, disease or injury and in accordance with accepted medical standards and practice could not have been omitted without adversely affecting the Insured Person’s medical condition.
Reasonable and Customary. An amount comparable to that charged by others of similar professional standing in the same locality, for the same class of hospital room, for a person of similar sex and age, for a similar disability, without regard to ability to pay or the availability or adequacy of insurance. Where an insured person stays in a hospital room above the hospital room and board level shown on the benefits schedule, reasonable and customary charges will be limited to comparable charges for the highest class of room for which the insured person is covered.
Reasonable and Customary. Reasonable and customary charges are the amounts measured and determined by comparing them with charges customarily made for similar services and supplies to individuals of similar medical condition in the locality concerned.
Reasonable and Customary within the usual range of charges being made by others of similar standing in the area in which the charge is incurred when providing the same or comparable services or supplies. your earnings, less deductions normally made for federal and provincial income tax.
Reasonable and Customary. This shall refer to the average amount charged in respect of eligible medical services or treatment costs, as determined by our experience in any particular country or territory A planned programme of treatment in which the convalescent or disabled person progresses towards, or maintains the maximum degree of physical and psychological independence of which he is capable. Refers to a disease or illness or injury resulting in a medical condition that is caused by a pre-existing condition or results from the same underlying cause as a pre-existing condition.
Reasonable and Customary. Charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness/injury involved.