Benefit Expense Clause Samples
The Benefit Expense clause defines how costs related to employee benefits are handled within an agreement. It typically specifies which party is responsible for providing and paying for benefits such as health insurance, retirement contributions, or other employee perks. For example, the clause may state that the employer will cover all benefit expenses for employees assigned to a project, or that such costs will be reimbursed by the client. Its core practical function is to allocate financial responsibility for benefit-related expenses, ensuring clarity and preventing disputes over who bears these costs.
Benefit Expense. The Department shall determine the Benefit Expense using the following data:
Benefit Expense. The Agency shall determine the Benefit Expense using the following data:
a) Paid Claims. Paid Claims shall be included in Benefit Expense. The Agency shall use Encounter Data claims for all dates of service during the Coverage Year and accepted by the Agency within six (6) months after the end of the Coverage Year. If the Contractor and Agency are unable to resolve Encounter Data systems issues prior to calculation of the MLR, a mutually agreed upon alternative method of calculating paid claims expense will be used. Encounter Data claims covered by sub-capitation contracts shall be priced at Contractor’s Fee-For-Service rate for Covered Services or the Agency’s designated pricing. Contractor shall provide clear supporting documentation of these sub-capitated arrangements. Incurred expenditures may, at the discretion of the Agency, be repriced at the Agency’s Medicaid fee-for-service equivalent rates.