Premium Rebates definition

Premium Rebates provision has been added to the “Miscellaneous Provisions” section of the Group Agreement, in accordance with the ACA. The provision clarifies the roles and responsibilities of Company and of Group in the event that a Premium rebate is required. The “Reporting Membership Changes and Retroactivity” provision under the “Miscellaneous Provisions” section of the Group Agreement has been modified. We have clarified that membership forms must be approved by Company.
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Premium Rebates means the adjustment to premiums paid by HCA to the Contractor in order to satisfy the minimum MLR requirement. If premiums paid result in an MLR of 80% then there will be Premium Rebate of 11.12% of premiums less taxes and fees so that the MLR will rise to 90%. If the Contractor owes a Premium Rebate, the Premium Rebate will be paid by the Contractor to HCA.
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Premium Rebates. The Premium formulary is OptumRx’s lead national formulary, with a limited number of exclusions that drive stronger rebates and the lowest cost to the Client. Premium PDL rebates are contingent upon: Client's adoption, without deviation, of OptumRx’s formulary and formulary exclusions, as well as any changes OptumRx makes to its formulary and formulary exclusions; and implementation of the step therapies required by OptumRx in the following therapeutic classes: Rheumatoid Arthritis, Ankylosing Spondylitis, Plaque Psoriasis, Psoriatic Arthritis, Hepatitis-C, Multiple Sclerosis, and PCSK9.  Select Base Rebates: Client's adoption, without deviation, of OptumRx’s formulary, as well as any changes OptumRx makes to its formulary; and a minimum of $10 difference in copayment, or 10 percent difference in coinsurance between preferred and non-preferred Brand Drugs.  Select Comprehensive Rebates: The Select Comprehensive formulary has an extensive list of utilization management programs, driving an improvement in rebate value as opposed to formularies with fewer formulary management requirements. Select Comprehensive rebates are contingent upon: Client's adoption, without deviation, of OptumRx’s formulary and utilization management programs, as well as any changes OptumRx makes to its formulary or utilization management programs; and a minimum of $10 difference in copayment, or 10 percent difference in coinsurance between preferred and non-preferred Brand Drugs.  Rebate claims exclude ineligible claims, such as claims with invalid service provider identification or prescription numbers; claims where, after meeting the deductible, the Member's Cost-Sharing Amount under the applicable Benefit Plan requires the Member to pay more than 50 percent of the claim; claims for devices without a Prescription Drug component; claims for re-packaged NDCs; stale dated claims over 180 days old; compounds; claims from 340B which typically receive a discount or rebate directly from Drug Manufacturers under section 340B of the Public Health Service Act, or claims from entities eligible for federal supply schedule prices (for example, Department of Veterans Affairs, U.S. Public Health Service, Department of Defense); or claims that are not for Prescription Drugs (except for insulin or diabetic supplies).  If Client makes any change to its formulary, not initiated by OptumRx, changes the Benefit Plan, or adopts any formulary or utilization management program other than one of the op...
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Examples of Premium Rebates in a sentence

  • HCA intends to reconcile the Premium Rebates relating to the MLR Incentive Threshold concurrently with the final Federal reconciliation of the MLR rebate.

  • Premium Rebates If state or federal law requires the Health Plan to rebate Premiums from this or any earlier contract year and the Health Plan rebates Premiums to the Group, those responsible to represent that the Group will use that rebate for the benefit of Members, in a manner consistent with the requirements of the Public Health Service Act, the Affordable Care Act and the obligations of a fiduciary under the Employee Retirement Income Security Act (ERISA).

  • Premium Rebates are contingent upon: County's adoption, without deviation, of Contractor’s Formulary and Formulary exclusions, as well as any changes Contractor makes to its Formulary and Formulary exclusions; and the implementation of the step therapies required by Contractor, as well as any changes Contractor makes to its Formulary and formulary exclusions; and the implementation of the step therapies required by Contractor, as well as any changes Contractor makes to its utilization management programs.

  • Premium Rebates If state or federal law requires the Health Plan to rebate Premium from this or any earlier Contract Year and the Health Plan rebates Premium to the Group, those responsible to represent the Group will use that rebate for the benefit of Members, in a manner consistent with the requirements of the Public Health Service Act, the Affordable Care Act and the obligations of a fiduciary under the Employee Retirement Income Security Act (ERISA).

Related to Premium Rebates

  • Premium pay Per the statute, recipients have broad latitude to designate critical infrastructure sectors and make grants to third-party employers for the purpose of providing premium pay or otherwise respond to essential workers. While the interim final rule generally preserves the flexibility in the statute, it does add a requirement that recipients give written justification in the case that premium pay would increase a worker’s annual pay above a certain threshold. To set this threshold, Treasury analyzed data Federal Register / Vol. 86, No. 93 / Monday, May 17, 2021 / Rules and Regulations 26817 from the Bureau of Labor Statistics to determine a level that would not require further justification for premium pay to the vast majority of essential workers, while requiring higher scrutiny for provision of premium pay to higher- earners who, even without premium pay, would likely have greater personal financial resources to cope with the effects of the pandemic. Treasury believes the threshold in the interim final rule strikes the appropriate balance between preserving flexibility and helping encourage use of these resources to help those in greatest need. The interim final rule also requires that eligible workers have regular in-person interactions or regular physical handling of items that were also handled by others. This requirement will also help encourage use of financial resources for those who have endured the heightened risk of performing essential work.

  • Premium tax means a tax paid by insurance companies to provincial and territorial governments calculated as a percentage of gross premiums written.

  • Premium payment plan means a benefit plan whereby state and

  • Premium Amount The amount of premium due to the Note Insurer in accordance with the terms of the Insurance Agreement.

  • Premium Due Date means date specified in the Schedule on which the Instalment Premium will become due.

  • Premium surcharge means a payment required from a subscriber, in addition to the subscriber's medical premium contribution, due to an enrollee's tobacco use or an enrolled subscriber's spouse or state registered domestic partner choosing not to enroll in their employer- based group medical when:

  • Rebates means rebates, price reductions, administrative fees and related adjustments charged by federal, state and local governmental programs and their participants, and by health plans, insurance companies, mail service pharmacies and health care providers based upon the utilization and sales of the Products, and service, administrative and inventory management fees due to wholesalers, distributors and group purchasing organizations based on sales of the Products.

  • Premium Loading means the additional premium on top of the Standard Premium charged by the Company to the Policy Holder according to the additional risk assessed for the Insured Person.

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Premium Payment Date in respect of any Option, means the date on which the Premium is due and payable, as agreed to at the time the Option is entered into, as evidenced in a Confirmation.

  • Premium service means programming choices (such as movie Channels, pay-per-view programs, or video on demand) offered to Subscribers on a per-Channel, per-program or per- event basis.

  • Premium Payment Term means the term specified in the Schedule, during which the Premiums are payable by You;

  • Premiums means premiums, considerations, deposits and similar receipts with respect to the Policies or Post-Closing Policies.

  • group insurance means insurance, other than creditor’s group insurance and family insurance, whereby the lives of a number of persons are insured severally under a single contract between an insurer and an employer or other person; (“assurance collective”)

  • Premium Mortgage Loan Any Group 1 Premium Mortgage Loan or Group 2 Premium Mortgage Loan.

  • Medicare cost report means CMS-2552-10, the cost report for electronic filing of

  • Insurance Premium means the amount that each Debtor shall pay on a monthly basis to Agos pursuant to the relevant Consumer Loan Agreement, in relation to the insurance premium paid by Agos to the relevant Insurance Company under any Financed Insurance Policy.

  • State premium tax liability means any liability

  • Insurance Contracts means the insurance or annuity policies and contracts, together with all binders, slips, certificates, endorsements and riders thereto, issued or entered into by any Insurance Company prior to the Closing.

  • Extra Premium means an additional amount charged by Us, as per Our Underwriting Policy, which is determined on the basis of disclosures made by You in the Proposal Form or any other information received by Us including medical examination report of the Life Insured.

  • Premium Rate has the meaning assigned to such term in the Premium Letter.

  • Insurance Contract means a contract (other than an Annuity Contract) under which the issuer agrees to pay an amount upon the occurrence of a specified contingency involving mortality, morbidity, accident, liability, or property risk.

  • Revenue sharing means sharing tax increment proceeds as defined in ORS 457.470.

  • Third Party Payments means the payment made through instruments issued from an account other than that of the beneficiary investor mentioned in the application form. However, in case of payments from a joint bank account, the first named applicant/investor has to be one of the joint holders of the bank account from which payment is made.

  • Premium Letter means the letter agreement dated the Closing Date among LBAC, the Issuer and the Note Insurer referring to payment of the Premium.

  • Cost-reimbursement contract means a contract under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms and the provisions of this code, and paid a fee, if any.