Benefit and Eligibility Determinations Sample Clauses

Benefit and Eligibility Determinations. PUGET SOUND HEALTH PARTNERS shall confirm Enrollees eligibility for Covered Services upon request of Participant or Contractor. PUGET SOUND HEALTH PARTNERS shall have the sole authority to determine the eligibility of Enrollees for benefits and whether services are included under the terms of the PUGET SOUND HEALTH PARTNERS Subscriber Agreements. Participant shall not take any action or make any representations regarding eligibility or benefits without having obtained information from PUGET SOUND HEALTH PARTNERS. Participant may appeal benefit and eligibility determinations in accordance with Section 7.02 of the Agreement. PUGET SOUND HEALTH PARTNERS will not reverse any prior determination of Covered Services as Medically Necessary unless PUGET SOUND HEALTH PARTNERS medical review determines that PUGET SOUND HEALTH PARTNERS authorized the services based upon material misrepresentation by the Participant or that the information provided to PUGET SOUND HEALTH PARTNERS is materially different from that which was reasonably available at the time of the original determination.
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Related to Benefit and Eligibility Determinations

  • Eligibility Determination The State or its designee will make eligibility determinations for each of the HHSC HMO Programs.

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

  • Salary Determination 12.5.1 A unit member shall receive a salary not less than the minimum salary nor more than the maximum salary (Articles 12.3 and 12.4) for the rank to which appointed, except as provided in Articles 4.15, 5.6, 10.6.1 or Article 10.6.1.1. The effective dates for salaries shall be the appropriate dates specified in Article 12.2.2.

  • Determination of Eligibility The Plan Administrator shall determine the eligibility of each Employee for participation in the Plan based upon information provided by the Employer. Such determination shall be conclusive and binding on all individuals except as otherwise provided herein or by operation of law.

  • Group Benefits Eligibility 7.2.1 Participation in the Plan shall be a condition of employment for all teachers commencing employment for a full school year.

  • Benefits Eligibility The City offers healthcare benefits to regularly appointed full-time and part-time employees and their qualified dependents. The plan is administered in compliance with all applicable federal, state, local laws, statutes and rules.

  • Contribution Eligibility You are eligible to make a regular contribution to your Xxxx XXX, regardless of your age, if you have compensation and your MAGI is below the maximum threshold. Your Xxxx XXX contribution is not limited by your participation in an employer-sponsored retirement plan, other than a Traditional IRA.

  • SALARY DETERMINATION FOR EMPLOYEES IN ADULT EDUCATION PCA Article B.3 does not apply in School District No. 34 (Abbotsford).

  • Adverse Benefit Determination An adverse benefit determination is any of the following:  Denial of a benefit (in whole or part),  Reduction of a benefit,  Termination of a benefit,  Failure to provide or make a payment (in whole or in part) for a benefit, and  Rescission of coverage, even if there is no adverse effect on any benefit. An appeal of an adverse benefit determination can be made either as an administrative appeal or as a medical appeal, as defined further in this section. Our Customer Service Department phone number is (000) 000-0000 or 0-000-000-0000.

  • TAX LIMITATION ELIGIBILITY In order to be eligible and entitled to receive the value limitation identified in Section 2.4 for the Qualified Property identified in Article III, the Applicant shall:

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