Eligibility and Benefit Verification Sample Clauses

Eligibility and Benefit Verification. BCBSM will provide Facility with a system and/or method to promptly verify eligibility and benefit coverages of Members; provided that any verification will be given as a service and not as a guarantee of payment.
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Eligibility and Benefit Verification. BCBS will provide Facility with a system and/or method to verify eligibility and benefit coverages of Members; provided that any such verification will be given as a service and not as a guarantee of payment.
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Eligibility and Benefit Verification. BCBSM will provide CRNA with a system and/or method to promptly verify eligibility and benefit coverages of Members; provided that any such verification by BCBSM will be given as a service and not as a guarantee of payment.
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Eligibility and Benefit Verification. HealthAmerica or other Member Company shall be responsible for the determination under each Program as to whether (i) a person receiving services, supplies, products or accommodations from an AHERF Provider is a Covered Individual, and (ii) the services, supplies, products and accommodation provided to a Covered Individual are Covered Services. The Member Company shall use its reasonable efforts to provide AHERF and AHERF Providers with real time access to the Member Company's eligibility files to verify a Covered Individual's eligibility and coverage. HealthAmerica agrees that such verification process shall be reasonable and consistently and uniformly applied to each HealthAmerica Participating Provider. HealthAmerica shall make eligibility determinations according to its then current policies. As to AHERF Providers being compensated on a capitation basis, if a Covered Individual's eligibility has been canceled retroactively, HealthAmerica may deduct from payments to be made to the AHERF Provider an amount equal to the capitation payments paid to the AHERF Provider on account of such Covered Individual after the date of the retroactive cancellation: provided, however, such amount shall not exceed an amount equal to three (3) months of capitation payments for such Covered Services. The AHERF Provider may bill xxxh Covered Individual for services rendered during such period of ineligibility, which billing shall not constitute a violation of Sections 5.9. If a Covered Individual's enrollment in an AHERF Provider's practice has been added retroactively for three (3) or more months, HealthAmerica shall make a capitation payment equal to three months of capitation payments for such Covered Individual. The foregoing financial terms and conditions shall be AHERF Provider's sole and exclusive remedy for failing to notify HealthAmerica or Member Company of a Covered Individual's enrollment in an AHERF Provider's practice. AHERF Providers shall provide health care services to Covered Individuals without prior verification of eligibility or authorization in cases of an emergency.
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Eligibility and Benefit Verification. Plan shall be responsible for the determination whether (i) a person receiving services, supplies, products or accommodations from a BJC Provider is a BJC Medicaid Member, and (ii) the services, supplies, products and accommodation provided to a BJC Medicaid Member are Covered Services. Plan shall provide BJC with the claims and eligibility reports attached hereto as EXHIBIT E and Plan shall use its reasonable efforts to provide BJC and BJC Providers in the future with real time access to Plan's eligibility files to verify BJC Medicaid Member eligibility and coverage. Plan agrees that its eligibility verification processes shall be reasonable and consistently and uniformly applied to each BJC Provider. Plan shall make eligibility determinations according to its then current policies.
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Eligibility and Benefit Verification. Provider will be responsible for verifying Member eligibility and coverage through such processes as BCBSM shall establish from time to time.
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Eligibility and Benefit Verification. Plan shall be responsible for the determination under each Benefit Plan covered under the scope of this Exhibit as to whether (i) a person receiving services, supplies, products or accommodations from a BJC Provider is a BJC Medicare Member, and (ii) the services, supplies, products and accommodation provided to a BJC Medicare Member are Covered Services. Plan shall provide BJC the claims and eligibility reports set forth in EXHIBIT E and shall use its reasonable efforts to provide BJC and BJC Providers in the future with real time access to Plan's eligibility files to verify BJC Medicare Member eligibility and coverage. Plan agrees that its eligibility verification processes shall be reasonable and consistently and uniformly applied to each BJC Provider. Plan shall make eligibility determinations according to its then current policies.
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Eligibility and Benefit Verification. Plan shall be responsible for the determination under each Benefit Plan covered under the scope of this Exhibit as to whether (i) a person receiving services, supplies, products or accommodations from a BJC Provider is a Member, and
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Related to Eligibility and Benefit Verification

  • Form and Timing of Severance Benefits The Severance Benefits described in Sections 3.3(a), 3.3(b), and 3.3(c) herein shall be paid in cash to the Executive in a single lump sum as soon as practicable following the Effective Date of Termination, but in no event beyond thirty (30) days after such date (with the actual payment date during such 30-day period to be determined by the Company in its discretion).

  • Description of Severance Benefits In the event the Executive becomes entitled to receive Severance Benefits, as provided in Sections 2.1 and 2.2 herein, the Company shall pay to the Executive and provide him with the following Severance Benefits:

  • Continued Benefits For a twenty-four (24) month period (or, if less, the number of months from the Date of Termination until the Executive would have reached age sixty-five (65)) after the Date of Termination, the Company shall provide the Executive with life insurance, health, disability and other welfare benefits ("Welfare Benefits") substantially similar in all respects to those which the Executive is receiving immediately prior to the Notice of Termination (without giving effect to any reduction in such benefits subsequent to the Potential Change in Control preceding the Change in Control or the Change in Control which reduction constitutes or may constitute Good Reason). Benefits otherwise receivable by an Executive pursuant to this Section shall be reduced to the extent substantially similar benefits are actually received by or made available to the Executive by any other employer during the same time period for which such benefits would be provided pursuant to this Section at a cost to the Executive that is commensurate with the cost incurred by the Executive immediately prior to the Executive's Date of Termination (without giving effect to any increase in costs paid by the Executive after the Potential Change in Control preceding the Change in Control or the Change in Control which constitutes or may constitute Good Reason); provided, however, that if the Executive becomes employed by a new employer which maintains a medical plan that either (i) does not cover the Executive or a family member or dependent with respect to a preexisting condition which was covered under the applicable Company medical plan, or (ii) does not cover the Executive or a family member or dependent for a designated waiting period, the Executive's coverage under the applicable Company medical plan shall continue (but shall be limited in the event of noncoverage due to a preexisting condition, to such preexisting condition) until the earlier of the end of the applicable period of noncoverage under the new employer's plan or the third anniversary of the Executive's Date of Termination. The Executive agrees to report to the Company any coverage and benefits actually received by the Executive or made available to the Executive from such other employer(s). The Executive shall be entitled to elect to change his level of

  • Severance Compensation and Benefits Not in Derogation of Other Benefits Anything to the contrary herein contained notwithstanding, the payment or obligation to pay any monies, or granting of any benefits, rights or privileges to Executive as provided in this Agreement shall not be in lieu or derogation of the rights and privileges that the Executive now has or will have under any plans or programs of or agreements with the Company, except that if the Executive received any payment hereunder, the Executive shall not be entitled to any payment under the Company’s severance policy for officers and directors.

  • Exclusion from Compensation Calculation By acceptance of this Agreement, you shall be deemed to be in agreement that the Units covered hereby shall be considered special incentive compensation and will be exempt from inclusion as “wages” or “salary” in pension, retirement, life insurance and other employee benefits arrangements of the Company and its Affiliates, except as determined otherwise by the Company. In addition, each of your beneficiaries shall be deemed to be in agreement that all such shares be exempt from inclusion in “wages” or “salary” for purposes of calculating benefits of any life insurance coverage sponsored by the Company or any of its Affiliates.

  • Standard Benefits During the Employment Period, Executive shall be entitled to participate in all employee benefit plans and programs, including paid vacations, generally available to other similarly situated Company executives, subject to the terms and conditions of the applicable plans.

  • Eligibility for Benefits A member will not be eligible to receive Long Term Disability benefits until their Income Protection benefits have expired.

  • Compensation and Benefit Plans Momentive shall not, and shall not permit any of its Subsidiaries to (i) other than in the ordinary course of business consistent with past practice, enter into, adopt, amend (except for such amendments as may be required by law) or terminate any Momentive Benefit Plan, or any other employee benefit plan or any agreement, arrangement, plan or policy between Momentive or a Subsidiary of Momentive and one or more of its directors or officers, (ii) except for normal payments, awards and increases in the ordinary course of business or as required by any plan or arrangement as in effect as of the date hereof, increase in any manner the compensation or other benefits of any director, officer or employee or pay any benefit not required by any plan or arrangement as in effect as of the date hereof or enter into any contract, agreement, commitment or arrangement to do any of the foregoing, (iii) enter into or renew any contract, agreement, commitment or arrangement (other than a renewal occurring in accordance with the terms thereof) providing for the payment to any director, officer or employee of such party of compensation or benefits contingent, or the terms of which are materially altered, upon the occurrence of any of the transactions contemplated by this Agreement (or any event closely associated therewith including without limitation any termination of employment), (iv) grant any stock option, restricted stock, restricted stock unit or other equity-related award pursuant to the Momentive Incentive Plan or otherwise on or after the date hereof or (v) enter into or amend any collective bargaining agreements, except in the ordinary course of business consistent with past practice.

  • Termination of Benefit Plans Effective as of the day immediately preceding the Closing Date, the Company shall terminate all Company Employee Plans that are “employee benefit plans” subject to ERISA including any Company Employee Plans intended to include a Code Section 401(k) arrangement (unless Buyer provides written notice to the Company no later than three Business Days prior to the Closing Date that such 401(k) plans shall not be terminated). Unless Buyer provides such written notice to the Company, no later than three Business Days prior to the Closing Date, the Company shall provide Buyer with evidence that such Company Employee Plan(s) have been terminated (effective no later than the day immediately preceding the Closing Date) pursuant to resolutions of the Company Board. The form and substance of such resolutions shall be subject to review and approval of Buyer. The Company also shall take such other actions in furtherance of terminating such Company Employee Plan(s) as Buyer may reasonably require. In the event that termination of the Company’s 401(k) Plan would reasonably be anticipated to trigger liquidation charges, surrender charges or other fees then the Company shall take such actions as are necessary to reasonably estimate the amount of such charges and/or fees and provide such estimate in writing to Buyer no later than ten Business Days prior to the Closing Date.

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