Services Instead of Cash Payments
- Participating Physician Groups (PPG)
(does not apply to HSP)
An allowable expense is a health care service or expense, including deductibles and copayments, covered at least in part by any of the health plans covering the person. When a health plan provides benefits in the form of services, the reasonable cash value of each service is considered an allowable expense and a paid benefit. An expense or service that is not covered by any of the health plans is not an allowable expense. The reasonable cash value of any services provided to the covered individual by any service organization is deemed an expense incurred by the individual, and the liability of the plan through the member's Evidence of Coverage (EOC) is reduced accordingly.