Enrollee Protections Sample Clauses

Enrollee Protections. The Contractor agrees to protect Enrollees from certain payment liabilities and not hold Enrollees liable for: a. Any and all debts of the Contractor if it should become insolvent; b. Payment for services provided by the Contractor if the Contractor has not received payment from the State for the services, or if the provider, under contract or other arrangement with the Contractor, fails to receive payment from the State or Contractor; c. The payments to providers that furnish covered services under a contract or other arrangement with the Contractor that are in excess of the amount that normally would be paid by the enrollee if the services had been received directly from the Contractor; and d. The Contractor agrees to honor and be bound by Section 1128B(d)(1) of the Balanced Budget Act of 1997 which protects Enrollees against balance billing by subcontractors.
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Enrollee Protections. 4.4.1 Provider acknowledges that in no event, including but not limited to nonpayment by or the insolvency of a Payer, breach of a Plan Contract, or breach of this Agreement, shall Provider xxxx, charge, collect a deposit, seek compensation, remuneration or reimbursement from an Enrollee or other persons acting on the Enrollee’s behalf, for Covered Services provided pursuant to this Agreement. Provider acknowledges that payment is not likely in these circumstances. Provider shall not maintain any action at law or equity against any Enrollee to collect any sum owed to Provider for Covered Services rendered pursuant to this Agreement. 4.4.2 Provider shall not xxxx Enrollees for the provision of otherwise Covered Services when a claim is denied as a result of Quality Improvement or Utilization Review determinations. 4.4.3 Provider shall not xxxx Enrollees for (i) failure to show up for, or timely cancel an appointment, or (ii) any “surcharge” as that term is defined in the Rules and Standards. 4.4.4 Provider shall not xxxx nor attempt to collect from an Enrollee (or any financially responsible Enrollee Representative) or any Third Party Payer, any amounts otherwise due for any Covered Services provided on or after the date of a Enrollee’s disenrollment from the Plan, unless the Plan Contract provides otherwise. 4.4.5 The Enrollee protections provided in Sections 4.5.1 through 4.5.4 hereof do not apply to the collection of charges for Non-Covered Services, provided that there is a full written disclosure or waiver (also referred to as an agreement to pay) on file, signed by the Enrollee, in advance of the service being provided, in accordance with Applicable Law. 4.4.6 Nothing in this Agreement or the Rules and Standards are intended to or shall be construed to require or encourage Provider to deny care to an Enrollee for Non-Covered Services or Referral care not otherwise authorized in accordance with the Rules and Standards. Payers shall not have the right to prohibit or otherwise limit Provider when acting within the lawful scope of practice from undertaking the following on behalf of an Enrollee: (i) advising or otherwise advocating for an Enrollee’s health status, medical care, or treatment options, including any alternative treatment that may be self- administered, that is Medically Appropriate even if such care or treatment is not covered under this Agreement or is subject to Patient Responsibility Fees; (ii) providing any and all information an Enrolle...
Enrollee Protections 

Related to Enrollee Protections

  • Job Protection 15.9.1 Subject to 15.10 below, an employee returning from parental leave is entitled to resume work in the same position or a similar position to the one they occupied at the time of commencing parental leave. A similar position means a position: (a) At the equivalent salary, grading; (b) At the equivalent weekly hours of duty; (c) In the same location or other location within reasonable commuting distance; and (d) Involving responsibilities broadly comparable to those experienced in the previous position. 15.9.2 Where applicable, employees shall continue to be awarded increments when their incremental date falls during absence on parental leave.

  • Eye Protection Where an employee is required by the College or by legislation, in order to perform his/her duties, to acquire and wear prescription eye protection, the employee shall provide the College with proof of purchase by March 1 each year and the College shall reimburse to such employee, on the first pay day of April in each year, up to a maximum of twenty dollars ($20.00); in situations other than the foregoing, the College, may in its discretion, (which discretion shall not be unreasonably exercised) reimburse such expense where it is recommended by the health and safety committee constituted under the Occupational Health and Safety Act.

  • Employee Protection Nothing in this Agreement or otherwise limits Executive’s ability to communicate directly with and provide information, including documents, not otherwise protected from disclosure by any applicable law or privilege to the Securities and Exchange Commission (the “SEC”), any other federal, state or local governmental agency or commission (“Government Agency”) or self-regulatory organization regarding possible legal violations, without disclosure to the Company. The Company may not retaliate against Executive for any of these activities, and nothing in this Agreement or otherwise requires Executive to waive any monetary award or other payment that Executive might become entitled to from the SEC or any other Government Agency or self-regulatory organization.

  • System Protection To prevent compromise of systems which contain DSHS Data or through which that Data passes: a. Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months of being made available. b. The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes. c. Systems containing DSHS Data shall have an Anti-Malware application, if available, installed. d. Anti-Malware software shall be kept up to date. The product, its anti-virus engine, and any malware database the system uses, will be no more than one update behind current.

  • Fire Protection Contractor shall take adequate and reasonable precautions to protect the Work against damage by fire and smoke. For example, without limitation, Contractor shall do the following:

  • TEACHER PROTECTION A. The teachers shall have the right to review those things in his/her personnel file to which he/she is entitled by Law. At the option of the teacher, a representative of the Association may be present for such review. Each file shall contain a record indicating reviewer and date of review, excluding school personnel official access for record maintenance. B. The teacher may submit a written notation regarding any material and the same will be attached to the file copy of the material in question. If the teacher is asked to sign material placed in his/her file, such signature will be understood to indicate his/her awareness of the material but in no instance shall said signature be interpreted to mean agreement with the content of the material. X. Any serious complaint made against a teacher by any parent, student, and other person will be promptly called to the attention of the teacher. D. If a teacher is to be disciplined or reprimanded by the Board or its designee, he/she shall be entitled to have a representative of the Association present. That representative shall be the teacher's choice between the building representative or another Association officer. E. Each teacher has the responsibility for maintaining proper student control and discipline throughout the school day as well as at school-sponsored activities where he/she is serving as a sponsor or chaperone. The teacher, however, has the primary responsibility for maintaining control and discipline in his/her classroom. The Board will give reasonable support and assistance to teachers with respect to maintenance of control and discipline. Whenever is appears that a particular pupil requires special attention, reasonable steps shall be taken to provide such attention. The teachers recognize that all disciplinary actions and methods invoked by them shall be in accordance with established Board policy. F. Any case of assault upon a teacher which is related to a school-centered problem shall be promptly reported to the Board or its designated representative. If the assault was by a pupil or pupils, the Administration shall promptly investigate the matter and determine suitable discipline for the assaulting pupil. This decision shall be communicated to the teacher concerned. If the assault is by an adult, who is not a pupil, the Board its designee representative shall promptly report the incident to the proper law enforcement authorities. G. A teacher may suspend a pupil from one (1) period, when the grossness of the offense, the persistence of the misbehavior, or the disruptive effect of the violation makes the continued presence of the student in that classroom intolerable. In such cases, the teacher will promptly (by the end of the school day) furnish the administrator or counselor full particulars of the incident. The teacher and the administration will cooperatively endeavor to achieve correction of student behavior through whatever avenues are reasonably available. H. School administrators and teachers will endeavor to achieve correction of the students' misbehavior through counseling and interviews with the child and his/her parents when warranted.

  • Child Protection The Contractor acknowledges that it (and its personnel) are aware of the requirements of the Child Protection (Working with Children) Act 2012 (NSW) and all related laws concerning child protection (Child Protection Laws). The Contractor will ensure that it (and its personnel) comply with the requirements of the Child Protection Laws and policies of the DoE relating to child protection as notified to the Contractor from time to time. The Contractor must, at the Contractor’s expense, certify that the Contractor and the Contractor’s personnel are not a prohibited person under any Child Protection Laws and undergo any other screening, such as the ‘Working with Children Check’, as required under Child Protection Laws or by the School (or DoE). Any of the Contractor’s personnel that is a prohibited person under any Child Protection Laws must not be engaged in providing any Services. The Contractor is to immediately advise the Department if it becomes aware that it (or its personnel) are the subject of a reportable allegation involving children.

  • INSURANCE PROTECTION A. The Board shall provide MESSA Plan 1 or Plan 2 described below by making payment of insurance premiums for a full twelve (12) month period each year of this Agreement for the teacher and his/her eligible dependents as defined by MESSA, subject to the provisions below. B. Each teacher shall elect either Plan 1 or Plan 2, provided, however, that if a husband and wife are both members of the bargaining unit, one shall select Plan 1 and the other Plan 2. Part-time teachers shall receive the Plan 1 premium rate on a pro rata basis (e.g., a teacher employed for three days per week will receive three-fifths of the premium rate due to a full-time teacher eligible for the same coverage). Those part-time Teacher electing Plan 1 shall pay the difference between the prorated amount and the full cost of the appropriate health insurance by direct payment or payroll deduction. C. The employer shall pay 80% of the total cost of the MESSA medical premium and deductible. 100% of the non-medical benefits. Additionally, the Board agrees to maintain this 80/20 cost-sharing provision during the life of this Agreement. Employees shall contribute 20% of the medical premium and the annual deductible. Employer shall fund 100% of the MESSA ABC Plan 1 annual deductible (minus the employees 20% contribution) to the employees’ Health Equity (HEQ) Health Savings Account (HSA) for each plan year. Deposits would be made in quarterly installments beginning on January 1, then April 1, then July 1, and the last installment on October 1 of each year. The District will fund the balance of the deductible due ahead of schedule for any member who incurs significant medical claims prior to receiving all four quarterly deposits. For teachers hired after January 1, the Employer will fund a percentage of the MESSA ABC Plan I annual deductible to the employees’ Health Equity” (HEQ) Health Savings Account (HSA) for each plan year equal to the percentage of the calendar year they work. Employee contributions shall be payroll deducted. Payments will start with the first pay date after the open enrollment period ends. The annual payment amount will be distributed equally throughout the remainder of the payroll dates for the school year through a qualified Section 125 plan and shall not be subject to withholding. The Employer’s qualified Section 125 plan shall include any and all of the provisions necessary for pre-tax contributions to employees’ HSA accounts. In the event an employee is not qualified for a Health Savings Account for any of the months of the deductible plan year, the employer shall contribute the negotiated amount of funding as set forth in the agreement to either a Flexible Spending Account (“FSA”) or a 403(b). Affected employees shall notify the employer where to contribute the money on or before December 15 of each school year. Employees may contribute, through payroll deduction and electronic transfer additional money towards their HSA up to the maximum amounts allowed by Federal Law. The parties understand that in the event the minimum deductible necessary for a medical plan to comply with HSA eligibility is increased beyond the current deductible level in MESSA ABC Plan 1, the deductible (and the Employer’s funding of the deductible) will automatically adjust to meet the federal minimum requirement. D. Benefit Plan 1 Plan 2 1. Health Insurance MESSA ABC Plan 1 Deductible $1400/$2800 ABC Rx SO OL/OV/SV $0 Coinsurance 2. Long Term Disability MESSA Same as Plan 1 Coverage 66 2/3% of salary up to $7,500 monthly maximum 90 calendar days modified fill Pre-existing condition waiver Alcohol/drug (same as any other illness) Mental/Nervous (same as any other illness) Soc. Sec. Offset- Primary Own- Occupation 2 years COLA- No SS Freeze- Yes 3. Dental Insurance MESSA/Delta Dental Same as Plan 1 Coverage Diag & Prev – 80% Basic Services- 80% (X Rays) Major services 80% Annual Max- $1800 Orthodontics- 80% Lifetime Max- UCR Riders- 2 cleanings, AO 4. Life Insurance MESSA Negotiated Term Same as Plan 1 Life $45,000 with $45,000 AD&D, Waiver of Premium 5. Vision Insurance MESSA Vision Enhanced Same as Plan 1 6. Options Not Available Pursuant to the terms of the District’s Section 125 Plan, All teachers electing to take the Plan 2 option in lieu of medical insurance shall receive 80% of the amount of the single subscriber premium rate for the insurance plan provided to other members of the association. (prorated for part-time Teacher). Cash in lieu payments will start with the first pay date after the open enrollment period ends. The annual payment amount will be distributed equally throughout the remainder of the payroll dates for the school year. Any modifications of the Section 125 Plan which affect bargaining unit members will be subject to negotiations with the Association.

  • Income Protection All workers will be covered by the extended Incolink Leisure Time Insurance and Income protection Scheme which provides defined weekly payments ($500 per week to workers with dependants, $400 per week to workers without dependants) for up to a maximum 104 weeks in the event of an extended work absence arising from any personal illness or injury (whether or not work related). The costs of this benefit will be shared between Incolink and the company on a 30/70 basis. Agreed premium costs will be: Incolink - $2.10 per week/worker Employer - $4.90 per week/worker It is a condition of the company’s agreement to provide this benefit that premium costs be maintained at not more than the February 1998 equivalent. In the event of premium costs escalating, the parties are agreed that the benefits table will be revised downwards so as to contain premium costs within the agreed limits. To maintain this cover the company agrees to pay the amounts every week for each employee. In the event the company does not maintain the above policy, the company will be liable in full to pay equivalent benefits to an employee who meets eligibility criteria as set out in the policy document.

  • Virus Protection The Bank is not responsible for any electronic virus or viruses that you may encounter. We suggest that you routinely scan your PC using a virus protection product. An undetected virus may corrupt and destroy your programs, files, and your hardware.

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