Additional Eligibility Parameters Sample Clauses

Additional Eligibility Parameters. Hospice. Enrollees who elect to enroll in the Hospice program while enrolled are not required to disenroll from the MCO’s SNBC SNP product. End Stage Renal Disease. SNBC SNP Enrollees who are identified by CMS as having ESRD after enrollment are not required to disenroll from the MCO’s SNBC SNP product. Individuals who develop ESRD while enrolled in a health plan (for example, a commercial or group health plan, or a Medicaid plan) offered by the MCO are eligible to elect the Medicare Advantage plan offered by that MCO. In order to be eligible, there must be no break in coverage between enrollment in the MCO, and the start of coverage in the Medicare Advantage plan offered by the same MCO. An individual who elects the SNBC SNP plan and who is medically determined to first have ESRD after the date on which the enrollment form is signed (or receipt date stamp if no date is on the form), but before the effective date of coverage under the SNBC SNP plan is still eligible to elect the SNBC SNP plan. Spenddown. SNBC SNP and SNBC non-SNP Enrollees who are enrolled into SNBC prior to acquiring a Medical Spenddown are not required to disenroll from SNBC provided the Enrollee agrees to pay the Medical Spenddown to the STATE on a monthly basis. Until further notice, the STATE will not enroll new Enrollees with Medical Spenddowns into SNBC. However, Potential Enrollees residing in a nursing facility and coded with a Medical (rather than Institutional) Spenddown because they have elected Hospice may be enrolled. Enrollees with a Medical Spenddown who are already enrolled in the MCO as of the effective date of this Contract are not required to disenroll from SNBC, subject to the payment of spenddown described in section 3.2.2(A)(5).
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Additional Eligibility Parameters 
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Related to Additional Eligibility Parameters

  • Service Eligibility Criteria 4.3.4.1 High capacity EELs must comply with the following service eligibility requirements:

  • Eligibility Changes Employees who become eligible for a full Employer Contribution must make their benefit elections within thirty (30) calendar days of becoming eligible. If employees do not choose a health plan administrator and a primary care clinic and do not waive coverage within this thirty (30) day timeframe, they will be enrolled in a Benefit Level Two clinic (or Level One, if available) that meets established access standards in the health plan with the largest number of Benefit Level One and Two clinics in the county of the employee’s residence at the beginning of the insurance year. If employees who become eligible for a partial Employer Contribution choose to enroll in insurance, they must do so within thirty (30) days of becoming eligible or during open enrollment. An employee may change their health or dental plan if the employee changes to a new permanent work or residence location and the employee's current plan is no longer available. If the employee has family coverage and if the new residence location is outside of the current plan’s service area, the employee shall be permitted to switch to a new plan administrator and new Benefit Level within thirty (30) days of the residence location change. The election change must be due to and correspond with the change in status. An employee who receives notification of a work location change between the end of an open enrollment period and the beginning of the next insurance year, may change their health or dental plan within thirty (30) days of the date of the relocation under the same provisions accorded during the last open enrollment period. An employee or retiree may also change health or dental plans in any other situation in which the Employer is required by the applicable federal or state law to allow a plan change.

  • Program Eligibility 1. All officers, regardless of assignment, will be eligible for the vehicle program subject to the limitations set forth below.

  • Special Eligibility The following employees also receive an Employer Contribution:

  • Funding Eligibility Contractor understands, acknowledges, and agrees that, pursuant to Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code, except as exempted under that Chapter, HHSC cannot contract with an abortion provider or an affiliate of an abortion provider. Contractor certifies that it is not ineligible to contract with HHSC under the terms of Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code.

  • General Eligibility i. A teacher who received an evaluation rating of ineffective or improvement necessary in the prior school year is not eligible for any salary increase and remains at their prior year salary.

  • Incentive Eligibility Conditions The IPTVO shall be entitled to avail of the Incentives, within the Territory, with effect from the date of execution of this Addendum, subject to the IPTVO meeting each of the following conditions (“Incentive Eligibility Conditions”):

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • Spousal Eligibility a. For employees hired on or after August 1, 2003: If the spouse of an employee is covered by any PEBTF health care plan, and he/she is eligible for coverage under another employer’s plan(s), the spouse shall be required to enroll in each such plan, which shall be the spouse’s primary coverage, as a condition of the spouse’s eligibility for coverage by the PEBTF plan(s), without regard to whether the spouse’s plan requires cost sharing or to whether the spouse’s employer offers an incentive to the spouse not to enroll.

  • Service Eligibility A bonus authorized by subsection (a) may be paid to a person or offi- cer only if the person or officer agrees under subsection (d)—

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