How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.
Notice of Appeal In the event that an employee who has been laid off out of seniority order believes the decision based upon performance and/or qualifications is incorrect, the employee may request that the Association appeal the Sheriff’s determination. If the Association finds there is good reason to believe that the Sheriff has erred in his decision, it may appeal through the process set forth in this Article. Such appeal shall be filed within five (5) working days of delivery of the layoff notice to the employee.
Appeal of Discipline Permanent unit members who are deprived of salary or other loss in compensation or property rights as a result of the imposed discipline may appeal the disciplinary decision under Article XXI, Section 21.3.5, Arbitration, of the Grievance Procedure. Nothing herein shall prevent the parties from mutually agreeing to utilize Step IV, Mediation, of Article XXI, prior to Step V, Arbitration.
Classification Appeal Procedure An employee shall have the right to appeal, through the Union, the classification of the position the employee occupies, or where a point rating plan has been used, the right to appeal the position's level. Classification matters are not grievable under Article 8 of this Agreement. Instead, the following procedures shall be followed.
Duration of Review This Articulation Agreement shall be effective from the date of affixing signatures and is subject to annual review by all parties affixing signatures. Any changes must be written and reflected in a new agreement. If no changes are indicated by the annual review, continuance of this agreement will remain in effect until terminated. Either party may terminate this agreement immediately without cause on 90 days written notice. In the event this agreement is terminated, students who are impacted shall have the opportunity to obtain credit according to the terms herein. Morehead State University ( MSU ) Responsibilities MSU shall be responsible for: ● Ensuring all institutional policies apply to articulated credit courses. ● Ensuring articulated credit is properly documented on postsecondary transcript in accordance with this agreement. ● Providing KDE with current postsecondary primary point of contact information to be published for general inquiries related to this Articulation Agreement and notifying KDE when updates are applicable. Secondary School (K-12) Responsibilities Secondary School (K-12) shall be responsible for: ● Providing detailed information to students in writing (i.e., a syllabus) consistent with the public postsecondary institution policy, which shall include the nature of the course and the expectations and requirements that correspond to its official catalog description. Course requirement information must include course prerequisites, course content, grading policy, attendance requirements, course completion requirements, performance standards, information on adding and dropping courses and other related course information. ● Promoting articulated credit opportunities among qualified high school students, parents and high school faculty. ● Ensuring proper Technical Education Data System (TEDS) data entry is maintained to allow for student testing. ● Ensuring articulated credit documentation (e.g., high school transcript with state course codes identified, CTE EOP assessment certificate(s), industry certification certificate(s)) is provided to the student upon meeting requirements. This document was completed by: bdavis Digitally signed by bdavis Date: 2018.12.10 14:14:21 -05'00' Articulation Agreement Kentucky Department of Education And Xxxxxxxx State University In Reference to Production Crop Career and Technical Education End-of-Program Assessment Agreement Number: AG - 18-19 - 0008 Signature Page The Kentucky Department of Education (KDE) and Morehead State University ( MSU ) enter into this Articulation Agreement on this 10 day of December , 20 18 . This Articulation Agreement shall be effective from the date of affixing signatures and is subject to annual review by all parties affixing signatures. Any changes must be written and reflected in a new agreement. If no changes are indicated by the annual review, continuance of this agreement will remain in effect until terminated. Either party may terminate this agreement immediately for cause or may terminate without cause on 90 days written notice. In the event this agreement is terminated, students who are impacted shall have the opportunity to obtain credit according to the terms herein. In testimony thereof, witness the duly authorized signatures of the parties hereto: Kentucky Department of Education Xxxxx X. Xxxxx, Ph.D. Commissioner of Education Date Morehead State University signed by Xxx Xxxxxx 1/3/2019
Resolution of Employee Dismissal or Suspension Disputes The following procedure shall be used for the resolution of disputes relating to the dismissal or suspension of an employee(s):
Procedure for Benefits Modifications 1. Proposals for major retirement benefit modifications will be negotiated in joint meetings with the certified employee organizations whose memberships will be directly affected. Agreements reached between Management and organizations whereby a majority of the members in LACERS are affected shall be recommended to the City Council by the CAO as affecting the membership of all employees in LACERS. Such modifications need not be included in the MOU in order to be considered appropriately negotiated.
Denial of Benefits Subject to prior notification and consultation, a Party may deny the benefits of this Chapter to: (a) investors of the other Party where the investment is being made by a enterprise that is owned or controlled by persons of a third State and the enterprise has no substantive business activities in the territory of the other Party; or (b) investors of the other Party where the investment is being made by a enterprise that is owned or controlled by persons of the denying Party.
Appeals Procedure If Employee appeals to the Administrator, Employee or his authorized representative may submit in writing whatever issues and comments he believes to be pertinent. The Administrator shall reexamine all facts related to the appeal and make a final determination of whether the denial of benefits is justified under the circumstances. The Administrator shall advise Employee in writing of:
Appeal Procedure The Appeal will be deemed an appeal of the entire Arbitration Award. In conducting the Appeal, the Appeal Panel shall conduct a de novo review of all Claims described or otherwise set forth in the Arbitration Notice. Subject to the foregoing and all other provisions of this Paragraph 5, the Appeal Panel shall conduct the Appeal in a manner the Appeal Panel considers appropriate for a fair and expeditious disposition of the Appeal, may hold one or more hearings and permit oral argument, and may review all previous evidence and discovery, together with all briefs, pleadings and other documents filed with the Original Arbitrator (as well as any documents filed with the Appeal Panel pursuant to Paragraph 5.4(a) below). Notwithstanding the foregoing, in connection with the Appeal, the Appeal Panel shall not permit the parties to conduct any additional discovery or raise any new Claims to be arbitrated, shall not permit new witnesses or affidavits, and shall not base any of its findings or determinations on the Original Arbitrator’s findings or the Arbitration Award.
