Dental Benefits Administrator Surveys Sample Clauses

Dental Benefits Administrator Surveys. HMOs using a Dental Benefits Administrator (DBA) must survey in- network dental providers twice per year. Results of this survey, and any subsequent remediation the HMO plans for their contracted DBA will be shared with DHS. The survey must include but is not limited to: specific questions to measure successful DBA communication, ability for providers to appeal, iii. general provider satisfaction, and iv. access and availability to covered services. Responsibility for Payment of Orthodontic and Prosthodontic Treatment When There is an Eligibility Status Change During the Course of Treatment Who pays for completion of orthodontic and prosthodontic treatment* when there is an enrollment status change First HMO Second HMO FFS Person converts from one status to another: 1. FFS to the HMO covering dental. N/A X 2a. HMO covering dental to the HMO not covering dental, and person’s residence remains within 50 miles of the person’s residence when in the first HMO. X 2b. HMO covering dental to the HMO not covering dental, and person’s residence changes to greater than 50 miles of the person’s residence when in the first HMO. X 3a. HMO covering dental to the same or another HMO covering dental and the person’s residence remains within 50 miles of the residence when in the first HMO. X 3b. HMO covering dental to the same or another HMO covering dental and the person’s residence changes to greater than 50 miles of the residence when in the first HMO. X
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Related to Dental Benefits Administrator Surveys

  • Supplemental Benefits The employer shall maintain a “Supplemental Unemployment Benefits Plan” pursuant to the Employment Insurance Act and Regulations. The employer shall make amendments as appropriate to ensure that the Plan provides the maximum permissible benefits in conjunction with Article 17.03.

  • Dental Benefits The County offers dental and orthodontic benefits to full and part-time regular employees and their eligible dependent(s). Benefit provisions, co­ payments and deductibles are outlined in the Evidence of Coverage. The employee contribution is $13 per pay period ($28.26 per month). The County shall contribute to part-time eligible employees on a pro-rated basis, in accordance with Section 10.2.6.

  • Retiree Medical Benefits If Executive is or would become fifty-five (55) or older and Executive's age and service equal sixty-five (65) and Executive has at least five (5) years of service with the Company within two (2) years of Change in Control, Executive is eligible for retiree medical benefits (as such are determined immediately prior to Change in Control). Executive is eligible to commence receiving such retiree medical benefits based on the terms and conditions of the applicable plans in effect immediately prior to the Change in Control.

  • Program Benefits Under the Probation Status, the Participating Contractor will be eligible for all contractor incentives, its customers will have access to financing offered through the Program, and income- eligible households will be eligible to receive Program incentives.

  • Dental Benefit (1) A confirmed staff shall be eligible for reimbursement of expenses incurred for restorative and preventive dental treatment up to $150 per calendar year.

  • Life Insurance Benefits A. During the life of this Agreement, the basic life insurance benefit made available to Faculty members shall be calculated as 3 times base annual earnings, rounded to the next highest $1,000, but not more than $225,000. A separate additional benefit up to the amount of the life insurance will be paid for accidental death and dismemberment, or loss of sight. The amount of Life and Accidental Death and Dismemberment/Loss of Sight benefits will be reduced to 65% at age 65, and further reduced (from the original insurance amount) as follows: to 50% at age 70, and 35% at age 75. Basic life insurance and AD&D benefits will be provided with no employee contributions.

  • Medical Benefits - Prescription Drugs Administered by a Provider (other than a pharmacist) This plan covers prescription drugs as a medical benefit, referred to as “medical prescription drugs”, when the prescription drug requires administration (or the FDA approved recommendation is administration) by a licensed healthcare provider (other than a pharmacist). Please note: Specialty prescription drugs meeting these requirements or recommendations are covered as a pharmacy benefit and not a medical benefit. These medical prescription drugs include, but are not limited to, medications administered by infusion, injection, or inhalation, as well as nasal, topical or transdermal administered medications. For some of these medical prescription drugs, the cost of the prescription drug is included in the allowance for the medical service being provided, and is not separately reimbursed.

  • Workplace Safety Insurance Benefits (WSIB) Top Up Benefits If the employee is in a class of employees that, on August 31, 2012, was entitled to use unused sick leave credits for the purpose of topping up benefits received under the Workplace Safety and Insurance Act, 1997;

  • Health Benefits Eligibility a. The State System shall provide an eligible permanent full-time active employee with health benefits. The State System shall provide permanent part-time employees who are expected to be in an active pay status at least fifty (50%) of the time every pay period with health benefits.

  • Covered Benefits and Services The Contractor shall provide to its Hoosier Healthwise members, at a minimum, all benefits and services deemed “medically reasonable and necessary” and covered by the IHCP, and included in the Indiana Administrative Code and under the Contract with the State. A covered service is considered medically necessary if it meets the definition as set forth in 405 IAC 5-2-17. The Contractor shall deliver covered services sufficient in amount, duration or scope to reasonably expect that provision of such services would achieve the purpose of the furnished services. Costs for these services are the basis of the Contractor’s capitation rate and are, therefore, the responsibility of the Contractor. Coverage may not be arbitrarily denied or reduced and is subject to certain limitations in accordance with CFR 438.210(a)(4), which specifies when Contractors may place appropriate limits on services:  On the basis of criteria applied under the State plan, such as medical necessity; or  For the purpose of utilization control, provided the services furnished are sufficient in amount, duration or scope to reasonably be expected to achieve the purpose for which the services are furnished.

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