Page 6 - Aegion PPO SPDs
P. 6
SCHEDULE OF BENEFITS
The Maximum Allowed Amount is the amount the Claims Administrator will reimburse for services and
supplies which meet its definition of Covered Services, as long as such services and supplies are not
excluded under the Member’s Plan; are Medically Necessary; and are provided in accordance with the
Member’s Plan. See the Definitions and Claims Payment sections for more information.
Under certain circumstances, if the Claims Administrator pays the healthcare provider amounts that are
Your responsibility, such as Deductibles or Coinsurance, the Claims Administrator may collect such
amounts directly from You. You agree that the Claims Administrator has the right to collect such amounts
from You.
6
The Maximum Allowed Amount is the amount the Claims Administrator will reimburse for services and
supplies which meet its definition of Covered Services, as long as such services and supplies are not
excluded under the Member’s Plan; are Medically Necessary; and are provided in accordance with the
Member’s Plan. See the Definitions and Claims Payment sections for more information.
Under certain circumstances, if the Claims Administrator pays the healthcare provider amounts that are
Your responsibility, such as Deductibles or Coinsurance, the Claims Administrator may collect such
amounts directly from You. You agree that the Claims Administrator has the right to collect such amounts
from You.
6
