Common use of Expanded Benefits Clause in Contracts

Expanded Benefits. The PH-MCO may provide expanded benefits subject to advance written approval by the Department. These must be benefits that are generally considered to have a direct relationship to the maintenance or enhancement of a Member’s health status. Examples of potentially approvable benefits include various seminars and educational programs promoting healthy living or illness prevention, memberships in health clubs and/or facilities promoting physical fitness and expanded eyeglass or eye care benefits. These benefits must be generally available to all Members and must be made available at all appropriate PH-MCO Network Providers. Such benefits cannot be tied to specific Member performance. However, the Department may grant exceptions in areas where it believes that such tie-ins shall produce significant health improvements for Members. Previously approved tie-ins will continue to remain in effect under this Agreement, unless the PH-MCO is notified, in writing, by the Department, to discontinue the expanded benefit. In order for information about expanded benefits to be included in any Member information provided by the PH-MCO, the expanded benefits must apply for a minimum of one full year or until the Member information is revised, whichever is later. Upon sixty (60) days advance notice to the Department, the PH-MCO may modify or eliminate any expanded benefits, which exceed the benefits provided for under the MA FFS Program. Such benefit(s) as modified or eliminated shall supersede those specified in the Proposal. The PH-MCO must send written notice to Members and affected Providers at least thirty (30) days prior to the effective date of the change in covered benefits and must simultaneously amend all written materials describing its covered benefit or Provider Network. A change in covered benefits includes any reduction in benefits or a substantial change to the Provider Network. For information to be included in materials to be used by the Enrollment Assistance Program (EAP), the expanded benefits must be in effect for the full calendar year for which the EAP information applies. EAP information will be updated annually on a calendar year basis.

Expanded Benefits. ‌ The PH-MCO may provide expanded benefits subject to advance written approval by the Department. These must be benefits that are generally considered to have a direct relationship to the maintenance or enhancement of a Member’s health status. Examples of potentially approvable benefits include various seminars and educational programs promoting healthy living or illness prevention, memberships in health clubs and/or facilities promoting physical fitness and expanded eyeglass or eye care benefits. These benefits must be generally available to all Members and must be made available at all appropriate PH-MCO Network Providers. Such benefits cannot be tied to specific Member performance. However, the Department may grant exceptions in areas where it believes that such tie-ins shall produce significant health improvements for Members. Previously approved tie-ins will continue to remain in effect under this Agreement, unless the PH-MCO is notified, in writing, by the Department, to discontinue the expanded benefit. In order for information about expanded benefits to be included in any Member information provided by the PH-MCO, the expanded benefits must apply for a minimum of one full year or until the Member information is revised, whichever is later. Upon sixty (60) days advance notice to the Department, the PH-MCO may modify or eliminate any expanded benefits, which exceed the benefits provided for under the MA FFS Program. Such benefit(s) as modified or eliminated shall supersede those specified in the Proposal. The PH-MCO must send written notice to Members and affected Providers at least thirty (30) days prior to the effective date of the change in covered benefits and must simultaneously amend all written materials describing its covered benefit or Provider Network. A change in covered benefits includes any reduction in benefits or a substantial change to the Provider Network. For information to be included in materials to be used by the Enrollment Assistance Program (EAP), the expanded benefits must be in effect for the full calendar year for which the EAP information applies. EAP information will be updated annually on a calendar year basis.

Expanded Benefits. The PH-MCO Contractor may provide expanded benefits subject to advance written approval by the Department. These must be benefits that are generally considered to have a direct relationship to the maintenance or enhancement of a Member’s 's health status. Examples of potentially approvable benefits include various seminars and educational programs promoting healthy living or illness prevention, memberships in health clubs and/or facilities promoting physical fitness and expanded eyeglass or eye care benefits. These benefits must be generally available to all Members and must be made available at all appropriate PH-MCO Contractor Network Providers. Such benefits cannot be tied to specific Member performance. However, the Department may grant exceptions in areas where it believes that such tie-ins shall produce significant health improvements for Members. Previously approved tie-ins will continue to remain in effect under this Agreement, unless the PH-MCO is notified, in writing, by the Department, to discontinue the expanded benefit. In order for information about expanded benefits to be included in any Member information provided by the PH-MCOContractor, the expanded benefits must apply for a minimum of one full year or until the Member information is revised, whichever is later. Upon sixty (60) days advance notice to the Department, the PH-MCO Contractor may modify or eliminate any expanded benefits, which exceed the benefits provided for under the MA FFS Program. Such benefit(s) as modified or eliminated shall supersede those specified in the Proposal. The PH-MCO Contractor must send written notice to Members and affected Providers at least thirty (30) days prior to the effective date of the change in covered benefits and must shall simultaneously amend all written materials describing its covered benefit or Provider Network. A change in covered benefits includes any reduction in benefits or a substantial change to the Provider Network. For information to be included in materials to be used by the Independent Enrollment Assistance Program (EAPIEAP), the expanded benefits must be in effect for the full calendar year for which the EAP IEAP information applies. EAP IEAP information will be updated annually on a calendar year basis.

Expanded Benefits. The PH-MCO Contractor may provide expanded benefits subject to advance written approval by the Department. These must be benefits that are generally considered to have a direct relationship to the maintenance or enhancement of a Member’s 's health status. Examples of potentially approvable benefits include various seminars and educational programs promoting healthy living or illness prevention, memberships in health clubs and/or facilities promoting physical fitness and expanded eyeglass or eye care benefits. These benefits must be generally available to all Members and must be made available at all appropriate PH-MCO Contractor Network Providers. Such benefits cannot be tied to specific Member performance. However, the Department may grant exceptions in areas where it believes that such tie-ins shall produce significant health improvements for Members. Previously approved tie-ins will continue to remain in effect under this Agreement, unless the PH-MCO is notified, in writing, by the Department, to discontinue the expanded benefit. In order for information about expanded benefits to be included in any Member information provided by the PH-MCOContractor, the expanded benefits must apply for a minimum of one full year or until the Member information is revised, whichever is later. Upon sixty (60) days advance notice to approval by the Department, the PH-MCO Contractor may modify or eliminate any expanded benefits, which exceed the benefits provided for under the MA FFS Program. Such benefit(s) as modified or eliminated shall supersede those specified in the Proposal. The PH-MCO Contractor must send written notice to Members and affected Providers at least thirty (30) days prior to the effective date of the change in covered benefits and must shall simultaneously amend all written materials describing its covered benefit or Provider Networkprovider network. A change in covered benefits includes any reduction in benefits or a substantial change to the Provider Networknetwork. For information to be included in materials to be used by the Independent Enrollment Assistance Program (EAPIEAP), the expanded benefits must be in effect for the full calendar year for which the EAP IEAP information applies. EAP IEAP information will be updated annually on a calendar year basis.