Beneficiary Grievances Sample Clauses

Beneficiary Grievances. APS PR and APS PR Providers agree to be governed and abide by Humana PR's grievance policies and procedures and the Health Insurance Contract's grievance procedure unless such procedures are preempted by any duly enacted law or regulation promulgated by ASES or any other governmental agency or department with jurisdiction over the parties. APS PR and APS PR Provider shall cooperate with Humana PR in resolving any Beneficiary grievances related to the provision of services to Beneficiaries. In this regard, APS PR and APS PR Providers agree to notify Humana PR within 5 business days whenever a Beneficiary files an informal or formal complaint or grievance, or legal action, against APS PR or an APS PR Provider. APS PR and APS PR Providers shall make every reasonable effort to promptly resolve any informal or formal complaint or grievance within 5 days. APS PR and APS PR Providers shall refer Beneficiaries who have complaints regarding health services, provider relations, benefits, or any other aspect of service to Humana PR's Member/Beneficiary Services Department. APS PR and the affected APS PR Provider shall cooperate with Humana PR in the investigation of any complaint, grievance or legal action, in accordance with Humana PR's grievance procedures. Upon request by Humana PR, APS PR and APS PR Provider shall provide full details of the nature, circumstances and disposition of any such complaint, grievance or legal action to Humana PR or its legal representative. APS PR and APS PR Provider agree to comply with and be bound in the disposition of all grievances or complaints, by the Health Insurance Contract grievance procedure.
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Beneficiary Grievances 

Related to Beneficiary Grievances

  • Policy Grievance – Union Grievance The Union may institute a grievance alleging a general misinterpretation or violation of this Agreement by the Employer by submitting a written grievance at Step No. 1 within twenty (20) days after the circumstances have occurred. This section shall not apply to disciplinary grievances or application of competitive clauses under this Agreement.

  • Policy Grievances Where either Party to this Agreement disputes the general application, interpretation or alleged violation of an Article of this Agreement, the dispute shall be discussed initially with the Site manager at Step 2 of the grievance procedure, their designate or the Union within fourteen (14) calendar days of the occurrence. Where no satisfactory agreement is reached, either Party, within a further fourteen (14) calendar days, may submit the dispute to a third party, as set out in Article 8 or 9 of this Agreement.

  • Grievances and Appeals a. If you have questions about any pediatric dental services received, please first discuss the matter with your Dental Provider. However, if you continue to have concerns, please call Delta Dental’s Customer Service Center. You can also email questions by accessing the “Contact Us” section of the dental plan website at xxx.xxxxxxxxxxxxxx.xxx.

  • Grievances Where an Employee alleges that she has been suspended or discharged in violation of Article 23.01, she may within ten (10) days of the date on which she was notified in writing or within twenty (20) days of the date of her discharge or suspension, whichever is later, invoke the grievance procedure including provisions for Arbitration contained in Article 26, and for the purpose of a grievance, alleging violation of Article 23.01 she may lodge her grievance at the final level of the grievance procedure.

  • Personal Grievances A personal grievance is a particular type of employment relationship problem that normally must be raised with the employer within 90 days of the grievance arising. An employee may have a personal grievance where: • They have been dismissed without good reason, or the dismissal was not carried out properly. • They have been treated unfairly. • Their employment or a condition of their employment has been affected to their disadvantage by an unjustified action of their employer. • They have experienced sexual or racial harassment, or have been discriminated against because of their involvement in a union or other employee organisation, or have suffered duress over membership or non-membership of a union or other employee organisation. • They have been discriminated against in terms of the prohibited grounds of discrimination under the Human Rights Act 1993.

  • Group Grievances No more than five (5) grievants will be permitted to attend grievance meetings.

  • Employee Grievances (a) Grievances on behalf of employees shall be handled as follows:

  • Policy Grievance – Employer Grievance The Employer may institute a grievance alleging a general misinterpretation or violation by the Union or any employee by filing a written grievance with the Bargaining Unit President, with a copy to the Labour Relations Officer within twenty (20) days after the circumstances have occurred. A meeting will be held between the parties within ten (10) days. The Union shall reply within ten (10) days after the meeting, and failing settlement, the matter may be referred to arbitration. (a) Where a difference arises between the parties relating to the interpretation, application or administration of this Agreement, including any questions as to whether a matter is arbitrable, or where an allegation is made that this Agreement has been violated, either of the parties may, after exhausting the grievance procedure established by this Agreement, notify the other party in writing of its decision to submit the difference or allegation to arbitration, and the notice shall contain the name of the first party's appointee to an Arbitration Board. The recipient of the notice shall, within ten (10) days, inform the other party of the name of its appointee to the Arbitration Board. The two appointees so selected shall within ten (10) days of the appointment of the second of them, appoint a third person who shall be the Chairperson. If the recipient of the notice fails to appoint a nominee, or if the two nominees fail to agree upon a Chairperson within the time limit, the appointment shall be made by the Minister of Labour for Ontario upon the request of either party. (b) Within thirty (30) calendar days of the receipt of notice referred to in Article 8.12(a) above, either party may require a process for a sole arbitrator where the grievance concerns: i) a job posting ii) a short term layoff

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