Enrollee Liability for Payment Sample Clauses

Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost- sharing requirements on Dual Eligible Members that would exceed the amounts permitted under the Rhode Island State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR§422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill EOHHS as applicable for any additional Medicare payments that may be reimbursed by Medicaid. Dual Eligible Members shall be responsible for any applicable Medicaid copayments.
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Enrollee Liability for Payment a) The MA Plan shall communicate fully integrated Medicare-Medicaid coverage to all members, providers, MA Plan staff, and other stakeholders, including guarantee of complete member protection from financial liability – meaning all deductibles, premiums, coinsurance, copayments, and cost sharing of any kind, with exception for member post-eligibility treatment of income payment, if applicable. b) The MA Plan shall include information and require providers to acknowledge and agree that they shall not xxxx or charge members the balance of a xxxx (“balance xxxx”) and that members are not liable for cost-sharing obligations.‌ c) As a general rule, if a participating or non-participating provider renders a covered service to an enrollee, the Provider’s sole recourse for payment, other than collection of any third party liability, is the MA Plan, not the enrollee. d) Notwithstanding any provision in this contract to the contrary, an enrollee shall not be responsible for the cost of care, except for enhanced services as described in the DHS- MCO Contract Art. VII.K.
Sample 1
Enrollee Liability for Payment. (a) The MA Health Plan and its contracted providers are prohibited from imposing cost-sharing requirements on Dual Eligible Members that would exceed the amounts permitted under the Kansas State Plan for Medical Assistance, per section 1852(a)(7) of the Act and 42 CFR §422.504(g)(1)(iii). (b) Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from billing a Dual Eligible Member with QMB benefits for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments. A Dual Eligible Member with QMB benefits has no legal obligation to make further payment to a provider or to the MA Health Plan for Medicare Part A or Part B cost sharing amounts. (c) The MA Health Plan’s provider agreements shall specify that a contracted Medicare provider agrees to accept the MA Health Plan’s Medicare reimbursement as payments in full for services rendered to Dual Eligible Members, or to bill the State Plan as applicable for any additional Medicare payments that may be reimbursed by Medicaid. (d) The MA Health Plan must notify its Subcontractors (via a provider manual, provider bulletin, or other contractual document) that they may not seek additional payments for Cost Sharing Obligations from a Dual Eligible Member for health care services rendered to Dual Eligible Members.
Sample 1
Enrollee Liability for Payment. (a) Neither the MA Health Plan nor any of its Subcontractors may collect any payment for Cost Sharing from a Dual Eligible Member other than what is allowed by federal or state law. (b) The following applies only to those categories of Dual Eligible Members as required by federal or state law: • The MA Dual SNP will not impose or permit its Subcontractors to collect cost sharing on Dual Eligible Members that exceeds the cost sharing permitted with respect to the Dual Eligible Member under Medicaid if the Dual Eligible Member were not enrolled in a MA-PD Plan. • The MA Health Plan must notify its Subcontractors (via a provider manual, provider bulletin, or other contractual document) that they may not seek payments for Cost Sharing from Dual Eligible Members for health care services rendered to Dual Eligible Members. • The MA Health Plan must notify its Subcontractors to seek payment from the Department for Cost Sharing for Dual Eligible Members according to the State Plan or accept payment from the MA Health Plan as a payment in full. The MA Health Plan must provide the Department contact identified in Section 7.08 with a copy of such written notice.
Sample 1
Enrollee Liability for Payment. (a) Neither the Contractor nor any of its subcontractors may collect any payment for cost sharing from a Dual Eligible member other than what is allowed by federal or state law. (b) The following applies only to those categories of Dual Eligible members as required by federal or state law: 1. The Contractor will not impose or permit its subcontractors to collect cost sharing from Dual Eligible members that exceeds the cost sharing permitted with respect to the Dual Eligible member under Medicaid if the Dual Eligible member were not enrolled in Contractor’s D-SNP. 2. The Contractor must notify its subcontractors (via a provider manual, provider bulletin, or other contractual document) that they may not seek payments for cost sharing from Dual Eligible members for health care services rendered. 3. The Contractor must notify its subcontractors to seek payment from the Department for cost sharing for Dual Eligible members according to the State Plan or accept payment from the D-SNP as a payment in full. The D-SNP must provide the Department contact identified in Section 7.08 with a copy of such written notice.
Sample 1

Related to Enrollee Liability for Payment

  • Responsibility for Payment The Company shall not be responsible for the payment of time used by an employee in the investigation and settlement of a grievance.

  • Employee Liability In the event an employee becomes a defendant in a civil liability suit arising out of actions taken or not taken in the course of his/her employment for the state, he/she has the right to request representation and indemnification through his/her agency in accordance with RCW 4.92.060 and 070 and agency policy.

  • Security for Payment To secure payment of all obligations due hereunder, the Customer hereby grants to Custodian a continuing security interest in and right of setoff against each Account and all Property held therein from time to time in the full amount of such obligations; provided that, if there is more than one Account and the obligations secured pursuant to this Section can be allocated to a specific Account or the Portfolio related to such Account, such security interest and right of setoff will be limited to Property held for that Account only and its related Portfolio. Should the Customer fail to pay promptly any amounts owed hereunder, Custodian shall be entitled to use available Cash in the Account or applicable Account, as the case may be, and to dispose of Securities in the Account or such applicable Account as is necessary. In any such case and without limiting the foregoing, Custodian shall be entitled to take such other action(s) or exercise such other options, powers and rights as Custodian now or hereafter has as a secured creditor under the New York Uniform Commercial Code or any other applicable law.

  • Retiree Benefits – Process for Payment Any bargaining unit nurse who retires and wishes to participate in the benefit plans as outlined in article 17.01(h) will provide advance payment of the benefits either through post-dated cheques provided on a yearly basis or through a preauthorized withdrawal process. It is understood that any transaction would be dated the first of each and every month. The Employer will notify the Union of the benefit costs to retired nurses in January of each year, and each time the benefit costs are renegotiated by the Employer.

  • Limitation of Liability for Payments Section 3.09 of the Basic Agreement shall be amended, with respect to the Applicable Trust, by deleting the phrase “the Owner Trustees or the Owner Participants” in the second sentence thereof and adding in lieu thereof “the Liquidity Provider”.

  • Application for Payment The form acceptable to Owner that is to be used by the Contractor during the course of the Work in requesting payment from the Owner and that is to be accompanied by such supporting documentation as is required by the Contract Documents.

  • Time for Payment Interconnection Customer must provide the additional Security, in a form and with terms as required by Section 212.4, within 15 days after its receipt of Transmission Provider’s notice under this section. The requirement for additional Security under this section shall be treated as a milestone included in the Interconnection Service Agreement pursuant to Section 212.5.

  • Termination Liability If any Pricing Agreement shall be terminated pursuant to Section 7 hereof, the Company shall not then be under any liability to any Underwriter with respect to the Designated Securities covered by such Pricing Agreement except as provided in Section 4(a)(viii) and Section 6 hereof; but, if for any other reason Designated Securities are not delivered by or on behalf of the Company as provided herein, the Company will reimburse the Underwriters through the Representatives for all out-of-pocket expenses approved in writing by the Representatives, including fees and disbursements of counsel, reasonably incurred by the Underwriters in making preparations for the purchase, sale and delivery of such Designated Securities, but the Company shall then be under no further liability to any Underwriter with respect to such Designated Securities except as provided in Section 4(a)(viii) and Section 6 hereof.

  • Release for Payment Upon receipt by the Collateral Custodian of the Servicer’s request for release of documents and receipt in the form annexed hereto as Exhibit M (which certification shall include a statement to the effect that all amounts received in connection with such payment or repurchase have been credited to the Collection Account as provided in this Agreement), the Collateral Custodian shall promptly release the related Required Loan Documents to the Servicer.

  • Violation; liability for unpaid wages; liquidated damages In the event of any violation of the clause set forth in paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1.) of this section.

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