Access to Benefits Sample Clauses

Access to Benefits. In no case shall an employee on layoff, who was eligible for health, dental or other employee benefits prior to layoff, be required to accept an offer of recall to a position which does not meet the hourly assignment threshold for access to previously available benefits.

Access to Benefits. Teachers placed on unrequested leave will continue to have access to health, dental, and life insurance benefits available to teachers on other leaves of absence, with costs to be borne by the teacher.

Access to Benefits. 1. The INSURER will contract all available private providers that meet its credentialing process and agree to its contractual terms, in order to assure sufficient participating providers, to satisfy the demand of covered services by the beneficiaries enrolled in the program. The physician/beneficiary ratio accepted is one (1) primary care physician for each eight hundred and fifty (850) beneficiaries; one (1) specialist (not primary care) for each one thousand one hundred (1,100) beneficiaries; and, one (1) physician (all) for each eight hundred (800) beneficiaries. These ratio does not take into account the expected mix between private patients and beneficiaries which could increase the physicians capacity to 1:1,700 for primary care physicians; 1:2,200 for specialists and 1:1,600 for all physicians. In the event that the HCOs provides services only to beneficiaries under this contract, the physician/beneficiary ratio will be the same to that applicable when there is a mix between private patients and beneficiaries. The INSURER will assure compliance with said physician/beneficiary ratio. 2. The INSURER shall be responsible to contract all the necessary health care services and participating providers to insure that all the benefits covered under the Basic, Dental and Special Coverage of the plan are rendered, through the INSURER's participating providers with the timeliness, amount, duration and scope as those services are rendered to non-enrolled Medicaid recipients within the area/region served. 3. Every subscriber shall be able to select from at least two (2) HCOs with sufficient enrollment capacity in his or her municipality, one of which will be a privatized government facility, if available and subject to compliance with INSURER's requirements for HCOs. Each subscriber shall also be able to choose a HCO outside his or her municipality of domicile as provided for in Article III, paragraph 1 of this contract. 4. A primary care physician can only act as such in only one (1) municipality within the Health Area/Region subject of this contract and must be available to attend the health care needs of the beneficiary on a twenty four (24) hour basis, seven (7) days a week. 5. Contracts between the INSURER and HCOs and between the INSURER and its participating providers shall be independent contracts specifically designed to cover all terms and conditions contained in this contract. Coverage afforded to beneficiaries under this contract constitutes a direct...

Access to Benefits. Participating Provider will make Covered Services available and accessible to Members twenty-four hours per day, seven days per week, when Medically Necessary, and with reasonable promptness and in a manner which assures continuity in the provision of Covered Services. [42 C.F.R. 422.112(a)(7)].

Access to Benefits. Provider shall make Covered Services available and accessible to Medicare Members on a twenty-four (24) hours per day, seven (7) days per week basis and with reasonable promptness and in a manner which assures continuity in the provision of Covered Services.

Access to Benefits. It is the responsibility of the Service Provider to support all Young People to make a benefit claim 7 weeks prior to their 18th birthday or at the earliest opportunity the local Jobcentre Plus will allow, working with the LA Allocated Worker to make sure that this takes place. Where a Young Person is placed with a Service Provider with less than 7 weeks till their 18th birthday or if they are already 18 or over the Service Provider will ensure that the Young Person is supported to lodge a claim within 7 days. The Service Provider is required to ensure young people claim Housing Benefit, Council Tax Support (where applicable) and any and all other benefits relevant for the Young Person.

Access to Benefits. It will not be necessary to prove a minimum period of previous Social Security contributions. The amount of the benefit will be 70 per cent for the entire duration of the measure. The maximum monthly amount to be received will be the equivalent of 225 per cent of the IPREM1 (Public Income Indicator for Multiple Effects), including the pro-rata extra payments, regardless of the family situation. It will be compatible with the performance of other part-time paid employment. In this case, the proportional part of the time worked shall not be deducted from the amount.

Access to Benefits. 1. INSURER shall contract with all available providers meeting INSURER’s credentialing process and which agrees to INSURER’s its contractual terms in order to (i) assure timely access to benefits provided herein; and (ii) provide sufficient participating providers to satisfy the demand of covered services with adequate capacity and services. The foregoing sentence may not be construed to (i) require that INSURER contracts with providers beyond the numbers necessary to meet the needs of its enrollees; (ii) preclude INSURER from using different reimbursement amounts for different specialties; (iii) or preclude INSURER from establishing measures that are designed to maintain quality of services and control costs, as long as they are consistent with its responsibilities to enrollees and any applicable guidelines established by the ADMINISTRATION. In establishing and maintaining an adequate network of providers, INSURER shall consider the following criteria: (i) Network Criteria • The anticipated Medicaid enrollment • The expected utilization of services, considering the specific, population characteristics and special health care needs in the INSURER’s Health Area/Region • The numbers and types of providers required to furnish the contracted services, taking in account experience, training and specialization • The number of providers not accepting new patients • The geographic location of providers and enrollees, considering distance, travel time, the means of transportation ordinarily used by enrollees and whether the location provides physical access for enrollees with disabilities or special needs.

Access to Benefits. 3.3.1 The HCO and TPA must contract with all available providers which meet the credentialing process, and agree with contractual terms related to assure timely access to benefits and ensure sufficient participating providers to satisfy the demand of covered services with adequate service capacity. These may not be construed to (i) require that TPA/HCO contract with providers beyond the numbers necessary to meet the needs of its enrollees; (ii) preclude TPA/HCO from using different reimbursement amounts for different specialties; (iii) or preclude TPA/HCO from establishing measures that are designed to maintain quality of services and costs control, as long as they are consistent with their responsibilities to enrollees and any applicable guidelines established by the ADMINISTRATION. Consistent with 42 CFR 438.214(c), the TPA/HCO provider selection policies and procedures cannot discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. In establishing and maintaining an adequate network of providers, TPA/HCO shall consider the following criteria: (i) Network Criteria • The anticipated Medicaid enrollment; The expected utilization of services considering the specific population characteristics and special health care needs in the Metro-North Region; • Integration of State, Academic Medical Centers, and Municipal Health Care Facilities and services in order that these facilities are considered as a primary choice for referral of the enrollee when the service is required, except in emergency cases or when said facilities are operating at full capacity; • The number and type of providers required to furnish the requested services considering experience, training and specialties; • The number of providers not accepting new patients; • The geographic location of providers and enrollees considering distance, travel time, the means of transportation ordinarily used by enrollees and whether the location provides physical access to enrollees with disabilities or special needs. (ii) Network ratios (iii) In-Network Providers a) General Practitioners b) Internists

Access to Benefits. APS shall arrange for MHSA Services to Advantra Members consistent with requirements of the M+C Program statutes, regulations, CMS pronouncements and CHC's policies.