Alternative Benefit Plan Clause Samples
The Alternative Benefit Plan clause defines the option for an employer or plan sponsor to offer a different set of benefits than the standard plan, typically to accommodate specific employee groups or regulatory requirements. This clause outlines the eligibility criteria for participation in the alternative plan, the scope of benefits provided, and any conditions or limitations that apply. Its core practical function is to provide flexibility in benefits administration, allowing organizations to tailor coverage to diverse needs while maintaining compliance and cost control.
Alternative Benefit Plan. Any employee who does not chose to receive medical coverage from the District and provides proof of coverage elsewhere, shall be eligible to receive $150.00 per month for ten (10) months annually. The amount shall be placed in a District approved Tax Sheltered Annuity plan. Part time employees shall be eligible to elect this Alternative Benefit prorated on the same basis as his/her salary pro-ration.
Alternative Benefit Plan. Effective January 1, 2014, the New Adult Group will receive benefits provided through the state’s approved alternative benefit plan (ABP) state plan amendment (SPA), which are effective, as of the effective date in the approved ABP SPA. Individuals in the New Adult Group may receive, as part of their ABP under this demonstration, Expenditure Authority services such as Managed Care Demonstration Only Benefits specified in Attachment A of the STCs.
Alternative Benefit Plan. A. The Contractor shall determine a recipient’s exemption from the New Mexico Medicaid Expansion Alternative Benefit Plan (ABP) based on criteria and procedures established by HSD.
B. The following individuals are exempt from mandatory participation in an ABP and may choose to receive full Medicaid State Plan benefits:
1. Individuals who qualify for medical assistance on the basis of being blind or disabled (or being treated as being blind or disabled) without regard to whether the individuals are eligible for Supplemental Security Income benefits;
2. Individuals who are terminally ill and are receiving benefits for hospice care;
3. Individuals who are medically frail or who have special medical needs. The following individuals are considered to be medically frail:
a) Individuals with disabling mental disorders, including adults with serious mental illness;
b) Individuals with chronic substance use disorders;
c) Individuals with serious and complex medical conditions;
d) Individuals with a physical, intellectual or developmental disability that significantly impairs their ability to perform one or more activities of daily living; and
e) Individuals with a disability determination based on Social Security criteria.
C. The Contractor shall perform utilization reviews of HSD-specified ABP Services according to the applicable Method and Categories of Reviews currently in place for Medicaid services (see sections 1.1(2) M and 1.1(2) N of this PSC).
Alternative Benefit Plan. The Newly Eligible Group, made eligible under the state plan effective January 1, 2014, will receive benefits described in the state’s approved alternative benefit plan (ABP) state plan amendment (SPA), which are effective, as of the effective date in the approved ABP SPA.
Alternative Benefit Plan. The Affordable Care Act Low-Income Adult Group will receive benefits provided through the state’s approved Alternative Benefit Plan (ABP) SPA.