Continuation of Benefits Pending Appeal Sample Clauses

Continuation of Benefits Pending Appeal. 3.10.1. Continuation of benefits for all prior-approved Medicare and Medicaid benefits that are terminated or modified, pending internal participating plan appeals, second level appeals at OAH, and third level appeals at Medicare Appeals Council must be provided if the original appeal is requested to the participating plan within ten (10) calendar days of the notice’s postmark date (of the decision that is being appealed) or by the intended effective date of the Action, whichever is later. 3.10.2. In the case of an appeal to the Medicare Appeals Council, the member must have received continuation of benefits during earlier level of appeals and file the appeal with OAH within ten (10) calendar days of the OAH decision in order to receive continuation of benefits during the appeal to the Medicare Appeals Council. If the participating plan’s Action is upheld, the member shall not be liable for the cost of any continued benefits.
Sample 1
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Continuation of Benefits Pending Appeal. Continuation of benefits for all prior-approved Medicare and Medicaid benefits that are terminated or modified, pending internal FIDA Plan appeals, Integrated Administrative Hearings, and Medicare Appeals Council must be provided if the original appeal is requested to the FIDA Plan within 10 calendar days of the notice’s postmark date (of the decision that is being appealed) or by the intended effective date of the Action, whichever is later.
Sample 1
Continuation of Benefits Pending Appeal. Continuation of benefits for all prior-approved Medicare and Medicaid benefits that are terminated or modified, pending internal FIDA-IDD Plan appeals, Integrated Administrative Hearings Unit, and Medicare Appeals Council must be provided if the original appeal is requested to the FIDA-IDD Plan within 10 calendar days of the notice’s postmark date (of the decision that is being appealed) or by the intended effective date of the Action, whichever is later. For benefits to continue pending appeal at the Medicare Appeals Council, the appeal to the Medicare Appeals Council must be requested within 10 calendar days of the postmark date of the Integrated Administrative Hearings Unit decision.
Sample 1
Continuation of Benefits Pending Appeal i. As provided in 42 CFR §431.211, and §431.230, §420, and §424, continuations of covered Medicaid services will continue to be required when a request is made within the applicable timeframes for making such request. This means that authorized benefits will continue to be provided, and that STAR+PLUS MMPs must continue to pay providers for providing services pending an internal STAR+PLUS MMP appeal or Fair Hearing request. Payments will not be recouped based on the outcome of the appeal for services covered during pending appeals. This right to aid pending an appeal currently exists in Medicaid, but generally is not currently available in Medicare. ii. Continuation of all Medicare Parts A and B and non-Part D benefits will be required to be provided pending internal STAR+PLUS MMP appeals. iii. In the case of a decision where the STAR+PLUS MMP, the HHSC Appeals Division, and the IRE all issue a ruling, the STAR+PLUS MMPs shall be bound by the ruling that is most favorable to the enrollee.
Sample 1
Continuation of Benefits Pending Appeal. If the Enrollee files a written request for Appeal with the STATE pursuant to Minnesota Statutes, Section 256.045, Subdivision 3a before the date of the proposed action in either the HEALTH PLAN’s DTR notice or the HEALTH PLAN’s formal Complaint decision, the HEALTH PLAN may not reduce or terminate the service until the STATE issues a written decision on the Appeal. In the case of a reduction or termination of ongoing services under Section 8.2.6., assuming all other requirements of the Section have been met, services must be continued pending outcome of all Internal Complaint Process and Administrative Appeal hearings if: (1) there is an existing order for services by the treating and Participating Provider, or (2) the treating and Participating Provider orders discontinuation of services and another Participating Provider orders the service, but only if that provider is authorized by his/her contract with the HEALTH PLAN to order such services. The notice required by Section 8.2.6. shall include this right.
Sample 1

Related to Continuation of Benefits Pending Appeal

  • Continuation of Benefits (i) For a period of three years following the Termination of Employment (the “Benefit Continuation Period”), the Employee shall be treated as if Employee had continued to be an executive for all purposes under the Company’s health insurance plan and dental insurance plan; or if the Employee is prohibited from participating in such plans, the Company shall otherwise provide such benefits. Employee shall be responsible for any employee contributions for such insurance coverage. Following the Benefit Continuation Period, Employee shall be entitled to receive continuation coverage under Part 6 of Title I of ERISA (“COBRA Benefits”) by treating the end of this period as the applicable qualifying event (i.e., as a termination of employment) for purposes of ERISA Section 603(2)) and with the concurrent loss of coverage occurring on the same date, to the extent allowed by applicable law. (ii) For the Benefit Continuation Period, the Company shall maintain in force, at its expense, the Employee’s life insurance in effect under the Company’s voluntary life insurance benefit plan as of the Change-in-Control Date or as of the date of Termination of Employment, whichever coverage limits are greater. For purposes of clarification, the portion of the premiums in respect of such voluntary life insurance for which Employee and the Company are responsible, respectively, shall be the same as the portion for which the Company and Employee are responsible, respectively, immediately prior to the date of Termination of Employment or the Change-in-Control Date, as applicable. (iii) For the Benefit Continuation Period, the Company shall provide short-term and long-term disability insurance benefits to Employee equivalent to the coverage that the Employee would have had Employee remained employed under the disability insurance plans applicable to Employee on the date of Termination of Employment, or, at the Employee’s election, the plans applicable to Employee as of the Change-in-Control Date. Should Employee become disabled during such period, Employee shall be entitled to receive such benefits, and for such duration, as the applicable plan provides. For purposes of clarification, the portion of the premiums in respect of such short-term and long-term disability benefits for which Employee and the Company are responsible, respectively, shall be the same as the portion for which Employee and the Company are responsible, respectively, immediately prior to the date of Termination of Employment or the Change-in-Control Date, as applicable. (iv) Notwithstanding anything in this Agreement to the contrary, in no event shall the provision of in-kind benefits pursuant to this Section 3 during any taxable year of Employee affect the provision of in-kind benefits pursuant to this Section 3 in any other taxable year of Employee.

  • Duration of Benefits Eligibility for Income Protection benefits will cease upon the earliest of the following dates: 1.09.01 the date the member is no longer disabled from performing the duties of their regular position, or any alternative employment made available to the member by the City. 1.09.02 the date the member's Income Protection benefits have been expended. 1.09.03 the date the member dies.

  • Extension of Benefits Upon termination of insurance, whether due to termination of eligibility, or termination of the Contract, an extension of benefits shall be provided for a period of no less than 30 days for completion of a dental procedure that was started before Your coverage ended.

  • Continuation of Health Benefits An employee on an approved Military Caregiver Leave shall be entitled to continue participation in health plan coverage (medical, dental, and optical) as if on pay status during the leave.

  • Termination of Benefits Except as provided in Section 2 above or as may be required by law, Executive’s participation in all employee benefit (pension and welfare) and compensation plans of the Company shall cease as of the Termination Date. Nothing contained herein shall limit or otherwise impair Executive’s right to receive pension or similar benefit payments that are vested as of the Termination Date under any applicable tax-qualified pension or other plans, pursuant to the terms of the applicable plan.

  • Cessation of Benefits An employee shall cease to be eligible for benefits of this Plan at the earliest of the following dates: (a) at the end of the month in which the employee reaches his/her sixty-fifth (65th) birthday; (b) on the date of commencement of paid absence prior to retirement; (c) on the date of termination of employment with the Employer. Benefits will not be paid when an employee is serving a prison sentence. Cessation of active employment as a regular employee shall be considered termination of employment except when an employee is on authorized leave of absence with or without pay.

  • 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.

  • Description of Benefits The benefits available under this Plan will be as defined in Items F(1), F(3), and F(4) of the Adoption Agreement.

  • Retention of Benefits Union leave under the following four (4) sections will be unpaid. The Employer will maintain regular pay and xxxx the Union for the costs of the employee’s salary and benefits. If the Union member is part-time or casual, and the leave is greater than their normal work hours, the Employer will pay the employee for the full length of the leave requested by the Union. The Employer will xxxx the Union for these days as noted above. The Union will pay these invoices within twenty-eight (28) days. Union leave is not unpaid leave for the purposes of Article 22.02 [i.e. such leave will not affect the employee’s benefits, seniority or increment anniversary date].

  • Suspension of benefits 1. The complaining Party may, at any time thereafter, communicate in writing to the Party complained against its intention to suspend the application of benefits in 30 days upon reception of such communication,if: (a) the disputing Parties are unable to agree on a compensation within 30 days after the period for establishing such compensation has begun, or the Party complained against has failed to observe the terms of the agreed compensation within 30 days following such agreement; (b) the Panel under the Article 187 (Examination of the Implementation) finds that the Party complained against fails to bring the measure found to be inconsistent with this Agreement into compliance with the recommendations of the Panel within the period of time established; or (c) the Party complained against expresses in writing that it will not implement the recommendations. 2. The complaining Party may initiate the suspension of benefits within 30 days following the latest date between the date of the communication pursuant to paragraph 1 of this Article and the date when the Panel issued its report pursuant to Article 190 (Examination of Benefit Suspension Level). 3. The level of benefits to be suspended shall have an equivalent effect to the benefits not being received. 4. In considering what benefits to suspend pursuant to paragraph 1: (a) the complaining Party should first seek to suspend benefits in the same sector or sectors affected by the measure; and (b) if the complaining Party considers that it is not practicable or effective to suspend benefits in the same sector or sectors, it may suspend benefits in other sectors. The communication in which it announces such a decision shall indicate the reasons on which it is based.

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