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HELPFUL TERMS
R.

Professional fees of non-Affiliated Physicians for services rendered to Members which do not exceed the standardized professional fees/terms of the Affiliated Physicians/Specialists. In cases where Maxicare does not have a standard professional fee for the professional service rendered, Maxicare reserves the right to determine the amount of reasonable charges for the said service.

  • An illness, condition, or disease which is associated with the particular diagnosis in question either as a direct symptom or sign, a risk factor, an underlying cause, a part of a syndrome, or a complication including complications of diagnostics and treatment.
  • The pre-assigned type of hospital room and board by Maxicare to the Member based on the benefit and coverage of the health care plan under this Agreement.

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