Beneficiary Protections. Medicare+Choice plans are required to meet a number of beneficiary protection requirements. They are required to disclose plan information to enrollees. They are required to have procedures relating to coverage decisions, reconsiderations, and appeals. Further, they are required to assure the confidentiality and accuracy of enrollee records.
Beneficiary Protections. The New Section 1860D-1 would establish guaranteed issue and community-rating requirements. The provision would specify that individuals electing qualified prescription drug coverage under a PDP plan or MA Rx or EFFS Rx plan could not be denied enrollment based on health status or other factors. MA provisions relating to priority
1) access to specific covered drugs, including access through pharmacy networks; 2) how any formulary used by the sponsor functioned; 3) copayment and deductible requirements (including any applicable tiered copayment requirements); and 4) grievance and appeals procedures. In addition, beneficiaries would have the right to obtain more detailed plan information. Plans would be required to have a mechanism for providing specific information to enrollees on request. The sponsor would be required to make available, through an Internet web site and, on request, in writing, information on specific changes in the formulary. Plans would be required to furnish to enrollees, at least monthly, a detailed explanation of benefits when drug benefits were provided, including information on benefits compared to the initial coverage limit and the applicable out-of-pocket threshold. PDP sponsors and entities offering an MA Rx or EFFS Rx plan would be required to permit the participation of any pharmacy that met the plan’s terms and conditions. A PDP and an MA Rx or EFFS Rx plan could reduce copayments for its enrolled beneficiaries below the otherwise applicable level for drugs dispensed through in-network pharmacies; in no case could the reduction result in an increase in subsidy payments made by the Administrator to the plan. PDP sponsors and entities offering an MA Rx or EFFS Rx plan would be required to secure participation in its network of a sufficient number of pharmacies that dispense drugs directly to patients (other than by mail order) to assure convenient access. The Administrator would establish convenient access rules that were no less favorable to enrollees than rules for convenient access established by the Secretary of Defense on June 1, 2003, for purposes of the TRICARE Retail Pharmacy program. The rules would include adequate emergency assess for enrolled beneficiaries. Sponsors would permit enrollees to receive benefits through a community pharmacy, rather than through mail-order, with any differential in cost paid by enrollees. Pharmacies could not be required to accept insurance risk as a condition of participation. PDP sponsor...
Beneficiary Protections. Eligible entities offering Medicare Prescription Drug Plans would be required to disclose plan information comparable to that required for MedicareAdvantage plans. Entities would have to disclose information on access, operation of any formulary, beneficiary cost-sharing, and grievance and appeals procedures. Further, upon request of an individual, they would be required to disclose general information on coverage, utilization, and grievance procedures. An eligible entity would be required to have a mechanism for providing specific information to enrollees, upon request, including information on coverage of specific drugs and changes in its formulary. Entities would be required to provide easily understandable explanation of benefits and a notice of benefits in relation to the initial coverage limit and the annual out-of-pocket limit. The MedicareAdvantage requirements relating to approval of marketing materials would apply to information provided by entities on drug plans.
Beneficiary Protections. New Section 1860D-4 establishes beneficiary protection requirements for qualified prescription drug plans. PDP plan sponsors are required to disclose, to each enrolling beneficiary, information about the plan’s benefit structure. The plan will disclose information on: 1) access to specific covered drugs (including access through pharmacy networks)
Beneficiary Protections. 3.1 The Guarantor acknowledges and agrees that the provisions of this Guarantee are and at all times shall be a continuing security and shall continue in effect until all sums demanded and due at any time from the Service Provider to TTL under the Agreement have been finally paid in full, and all obligations of the Service Provider under the Agreement have been fully performed, notwithstanding any intermediate payment, partial settlement or partial performance or other matter,
3.2 The Guarantor acknowledges and agrees that none of its liabilities or obligations under this Guarantee shall be reduced, discharged, released or otherwise adversely affected by:
(A) any provision of the Agreement (however fundamental and whether or not more onerous), including any or replacement of any provision of the Agreement;
(B) any variation, novation, restatement, extension, discharge, compromise, dealing with, exchange or renewal of any right or remedy which TTL may now or hereafter have from or against the Service Provider and any other person in respect of any of the Service Provider’s obligations under the Agreement;
(C) any of the administration, receivership, insolvency, bankruptcy, liquidation, winding-up, incapacity or any change in the constitution of the Service Provider; or
(D) any act, omission, matter or thing which would not have discharged or affected the liability of the Guarantor had it been a principal debtor instead of guarantor or indemnitor or by anything done or omitted by any person which but for this provision might operate to exonerate or discharge the Guarantor or otherwise reduce, release, prejudice or extinguish its liability under this Guarantee (without limitation and whether or not known to it or TTL) including but not limited to:
(1) any time, waiver or consent granted to, or composition with, the Service Provider or any other person in relation to any of the matters set out in clause 3.2(C) above;
(2) the release of the Service Provider or any other person under the terms of any composition or arrangement with any creditor in relation to any of the matters set out in clause 3.2(C) above;
(3) the taking, variation, compromise, exchange, renewal or release of, or refusal or neglect to perfect, take up or enforce, any rights against, or security over assets of, the Service Provider or other person or any non-presentation or non-observance of any formality or other requirement in respect of any instrument or any failure to realise the full valu...
Beneficiary Protections referral requirements.
(a) If a beneficiary or prospective beneficiary of a social service program supported by direct DOL financial as- sistance objects to the religious char- acter of an organization that provides services under the program, that orga- nization must promptly undertake rea- sonable efforts to identify and refer the beneficiary or prospective beneficiary to an alternative provider to which the beneficiary or the prospective bene- ficiary has no objection.
Beneficiary Protections referral requirements.
(a) If a beneficiary or prospective beneficiary of a social service program supported by direct DOL financial as- sistance objects to the religious char- acter of an organization that provides services under the program, that orga- nization must promptly undertake rea- sonable efforts to identify and refer the beneficiary or prospective beneficiary to an alternative provider to which the beneficiary or the prospective bene- ficiary has no objection.
(b) A referral may be made to an- other religious organization, if the ben- eficiary has no objection to that pro- vider. But if the beneficiary requests a secular provider, and a secular provider is available, then a referral must be made to that provider.
(c) Except for services provided by telephone, internet, or similar means, the referral must be to an alternative provider that is in reasonable geo- graphic proximity to the organization making the referral and that offers services that are similar in substance and quality to those offered by that or- ganization. The alternative provider also must have the capacity to accept additional clients.
(d) When the organization makes a referral to an alternative provider, the organization shall maintain a record of that referral for review by the award- ing entity. When the organization de- termines that it is unable to identify an alternative provider, the organiza- tion shall promptly notify and main- tain a record for review by the award- ing entity. If the organization is unable to identify an alternative provider, the awarding entity shall determine whether there is any other suitable al- ternative provider to which the bene- ficiary may be referred.
(e) A DOL social service inter- mediary provider that receives a re- quest for assistance in identifying an alternative provider may request as- sistance from DOL.
(f) The obligations in this section apply only to religious organizations providing services under social service programs administered in the United States. [81 FR 19423, Apr. 4, 2016]
Beneficiary Protections. 3.1 This Guarantee is a continuing guarantee and shall remain in full force and effect until all Guaranteed Obligations have been paid in full.
3.2 The liability of the Guarantor under this Guarantee shall not be reduced, discharged or otherwise adversely affected by:
(a) any intermediate payment, settlement of account or discharge in whole or in part of the Guaranteed Obligations;
(b) any variation, extension, discharge, compromise, dealing with, exchange or renewal of any right or remedy which a Beneficiary may now or after the date of this Guarantee have from or against a Guaranteed Company or any other person in connection with the Guaranteed Obligations;
(c) any act or omission by a Beneficiary or any other person in taking up, perfecting or enforcing any security, indemnity, or guarantee from or against a Guaranteed Company or any other person;
(d) any termination, amendment, variation, novation, replacement or supplement of or to any of the Guaranteed Obligations;
(e) any grant of time, indulgence, waiver or concession to a Guaranteed Company or any other person;
(f) any insolvency, bankruptcy, liquidation, administration, winding up, incapacity, limitation, disability, the discharge by operation of law, or any change in the constitution, name or style of a Guaranteed Company, a Beneficiary, or any other person;
(g) any invalidity, illegality, unenforceability, irregularity or frustration of any actual or purported obligation of, or security held from, a Guaranteed Company or any other person in connection with the Guaranteed Obligations;
(h) any claim or enforcement of payment from a Guaranteed Company or any other person;
(i) any act or omission which would not have discharged or affected the liability of the Guarantor had it been a principal debtor instead of a guarantor; or
(j) any other act or omission except an express written release by deed of the Guarantor by the Beneficiaries.
3.3 Notwithstanding any other provision of this Guarantee the obligations guaranteed by the Guarantor and the liability of the Guarantor under this Guarantee shall not exceed the liability of the Guaranteed Companies under the FSRU Agreements.
3.4 Subject to Clause 2.3, the Guarantor shall be entitled to exercise all of the contractual protections, limitations and exclusions of liability in respect of any claim made hereunder as are available to the Guaranteed Companies under the FSRU Agreements.
3.5 Neither Beneficiary shall be obliged, before taking steps to ...
Beneficiary Protections. This Guarantee is a continuing guarantee and shall remain in full force and effect until all
Beneficiary Protections
