Group Health Plans to which the Affordable Care Act Applies Sample Clauses

Group Health Plans to which the Affordable Care Act Applies. In the case of a Group Health Plan that is not an Excepted Benefit and to which the Affordable Care Act applies, the following additional procedures shall also apply (if and to the extent required by the Affordable Care Act guidance): 1) The Plan shall provide the claimant, free of charge, with any new or additional evidence considered, relied upon, or generated by the Plan (or at the direction of the Plan) in connection with the claim; such evidence must be provided as soon as possible and sufficiently in advance of the date on which the notice of final internal Adverse Benefit Determination is required to be provided under subsection (c) (pursuant to 29 C.F.R. § 2560.503-1(i)) to give the claimant a reasonable opportunity to respond prior to that date; and 2) Before the Plan can issue a final internal Adverse Benefit Determination based on a new or additional rationale, the claimant must be provided, free of charge, with the rationale; the rationale must be provided as soon as possible and sufficiently in advance of the date on which the notice of final internal Adverse Benefit Determination is required to be provided under subsection (c) (pursuant to 29 C.F.R. § 2560.503-1(i)) to give the claimant a reasonable opportunity to respond prior to that date. Notwithstanding the rules of 29 C.F.R. § 2560.503–1(i), if the new or additional evidence is received so late that it would be impossible to provide it to the claimant in time for the claimant to have a reasonable opportunity to respond, the period for providing a notice of final internal Adverse Benefit Determination is tolled until such time as the claimant has a reasonable opportunity to respond. After the claimant responds, or has a reasonable opportunity to respond but fails to do so, the Plan shall notify the claimant of the Plan’s benefit determination as soon as a plan acting in a reasonable and prompt fashion can provide the Notice, taking into account the medical exigencies.
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Related to Group Health Plans to which the Affordable Care Act Applies

  • Affordable Care Act The Affordable Care Act requires a Contractor, if Contractor is an applicable large employer under the ACA, to provide healthcare coverage for its employees who provide services for the State and work for 30 or more hours per week. This coverage must also cover the eligible employee’s dependents under the age of 26. The coverage must (a) meet the minimum essential coverage, minimum value, and affordability requirements of the employer responsibility provisions under Section 4980H of the Code (ACA), and (b) otherwise satisfy the requirements of the Code § 4980H (ACA).

  • Family and Medical Leave Act (FMLA In accordance with the Family and Medical Leave Act (FMLA) of 1993, the Board will grant a leave of absence for one or more of the following: 1. Because of the birth of a son or daughter of the employee, and in order to care for such son or daughter; 2. Because of the placement of a son or daughter with the employee for adoption or xxxxxx care; 3. To care for the employee's spouse, son or daughter, or par- ent, in laws or members of blended families or other per- sons in a similar relationship that live in the family house- hold or are in a similar family relationship who has a serious health condition; or, 4. The employee is unable to perform the essential job func- tions because of a serious health condition. As of February 2008, an employee who is the spouse, son, daughter, parent or the next of kin of a covered service mem- ber can take up to 26 weeks of FMLA leave during a single twelve (12) month period to care for the injured service mem- ber. The same eligibility requirements apply for employees requesting a leave under this category. Regulations as estab- lished by the Department of Labor will be followed when granting leaves under this provision. FMLA leaves are only available to employees who have been employed by the District for at least twelve (12) months and have worked 1,250 hours during the previous twelve (12) month period. Such leaves are counted against an employee's annual FMLA leave entitlement. Under the FMLA, an employee is eligible for a total of twelve (12) work weeks of leave in a twelve (12) month period. This twelve (12) month period is measured back from the date a requested leave is to begin. Continuation of medical, optical and dental benefits and the right to job restoration ceases when an employee has used twelve (12) work weeks of FMLA leave in the twelve (12) month period. (See Section B, Medical Leave of Absence). An employee requesting a FMLA leave must provide the Xxxxx- xxxx Superintendent of Human Resources at least thirty (30) days advance notice of when the leave is to begin. If such no- xxxx is not practicable, then notice is to be provided as soon as practicable. When a leave denoted as (1) or (2) above is granted, the leave must be taken in one (1) continuous increment, and must be concluded within twelve (12) months of the date of birth or placement. Employees granted such leave must utilize accu- mulated vacation days and accumulated personal business days (in that order), after which time the leave is unpaid. When a leave denoted as (3) above is granted, the employee must utilize accumulated sick leave time, accumulated vacation days, and accumulated personal business days (in that order), after which time the leave is unpaid. When a leave denoted as (4) above is granted, the employee must utilize accumulated sick leave days and accumulated per- xxxxx business days (in that order), after which time the leave is unpaid. After these days have been used and if more sick time is needed, the employee may choose to use accumulated vacation time. When additional time is needed during the 90 calendar day (13 week) LTD elimination period, the employee may use available vacation days. If the employee has pur- chased and is filing for short term disability, vacation days may be used during the 14 day elimination period. Vacation days cannot be used once the short term disability coverage starts. Leaves denoted as (3) or (4) above must be supported by med- ical certification from a health care provider stating (1) the date on which the serious health condition commenced, (2) the probable duration of the condition, (3) the appropriate medical facts, and (4) a statement that the employee is unable to per- form the essential functions of his/her position, or that the em- ployee is needed to care for the person. The District reserves the right to require the employee to obtain the opinion of a sec- ond health care provider designated or approved by the District concerning any information within the medical certification. When a FMLA leave denoted as (1) or (2) above is granted to spouses who are both employed by the District, the total amount of time on leave (in total for both employees) cannot exceed twelve (12) weeks of FMLA time. At the expiration of a medical leave or if the employee wishes to return to work before completion of the leave, there must be a physician's certification confirming his/her fitness to return to work. The District may condition the employee's return to work upon a fitness for duty examination and approval by a health care provider designated by the District. The District will continue to provide an employee's medical, optical and dental insurance while he/she is on a FMLA leave for a period of up to twelve (12) weeks on the same terms and conditions as prior to the leave. An employee on a FMLA leave shall not engage in any outside or supplemental employment. The District may recover insurance premiums paid while an employee was on an unpaid FMLA leave if: 1. The employee fails to return to work for at least thirty (30) days after the expiration of the leave; and 2. The failure to return is for a reason other than a serious health condition, or other circumstances beyond the control of the employee. Certification from the health care provider may be required for this purpose. An employee returning from a FMLA leave will be restored to the position he/she left, or to an equivalent position with equiv- alent benefits, pay and other terms and conditions of employ- ment. If the employee has not satisfactorily completed the probation- ary period at the commencement of a FMLA leave, then upon cessation of the leave, the employee must work the days need- ed to complete the probationary period.

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for 130 workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this Section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Personnel Commission.

  • Family and Medical Leave Act of 1993 The parties agree that the Employer may adopt policies to implement the Family and Medical Leave Act of 1993 that are in accord with what is legally permissible under the Act.

  • OMNIBUS PROCUREMENT ACT OF 1992 It is the policy of New York State to maximize opportunities for the participation of New York State business enterprises, including minority and women-owned business enterprises as bidders, subcontractors and suppliers on its procurement contracts. Information on the availability of New York State subcontractors and suppliers is available from: NYS Department of Economic Development Division for Xxxxx Xxxxxxxx Xxxxxx, Xxx Xxxx 00000 Telephone: 000-000-0000 Fax: 000-000-0000 email: xxx@xxx.xx.xxx A directory of certified minority and women-owned business enterprises is available from: NYS Department of Economic Development Division of Minority and Women's Business Development 000 Xxxxx Xxxxxx Xxx Xxxx, XX 00000 212-803-2414 email: xxxxxxxxxxxxxxxxx@xxx.xx.xxx xxxxx://xx.xxxxxxxxxxxxxx.xxx/FrontEnd/VendorSearchPu blic.asp The Omnibus Procurement Act of 1992 requires that by signing this bid proposal or contract, as applicable, Contractors certify that whenever the total bid amount is greater than $1 million: (a) The Contractor has made reasonable efforts to encourage the participation of New York State Business Enterprises as suppliers and subcontractors, including certified minority and women-owned business enterprises, on this project, and has retained the documentation of these efforts to be provided upon request to the State; (b) The Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L. 92-261), as amended; (c) The Contractor agrees to make reasonable efforts to provide notification to New York State residents of employment opportunities on this project through listing any such positions with the Job Service Division of the New York State Department of Labor, or providing such notification in such manner as is consistent with existing collective bargaining contracts or agreements. The Contractor agrees to document these efforts and to provide said documentation to the State upon request; and (d) The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with the State in these efforts.

  • Please see the current Washtenaw Community College catalog for up-to-date program requirements Conditions & Requirements

  • Family and Medical Leave (FMLA FMLA leave shall be granted pursuant to applicable law.

  • Family and Medical Leave Act The Family and Medical Leave Act will be followed in approving a Leave of Absence. Contract provisions that provide greater benefits than the Family and Medical Leave Act will be followed.

  • Family Medical Leave Act (FMLA A. The State acknowledges its commitment to comply with the spirit and intent of the leave entitlement provided by the FMLA and the California Family Rights Act (CFRA) referred to collectively as "FMLA." The State and the Union recognize that on occasion it will be necessary for employees of the State to take job- protected leave for reasons consistent with the FMLA. As defined by the FMLA, reasons for an FMLA leave may include an employee's serious health condition, for the care of a child, spouse, or parent who has a serious health condition, and/or for the birth or adoption of a child. B. For the purposes of providing the FMLA benefits the following definitions shall apply: 1. An eligible employee means an employee who meets the eligibility criteria set forth in the FMLA; 2. An employee's child means any child, regardless of age, who is affected by a serious health condition as defined by the FMLA and is incapable of self care. "Care" as provided in this section applies to the individual with the covered health condition;

  • Health Care Spending Account After six (6) months of permanent employment, full time and part time (20/40 or greater) employees may elect to participate in a Health Care Spending Account (HCSA) Program designed to qualify for tax savings under Section 125 of the Internal Revenue Code, but such savings are not guaranteed. The HCSA Program allows employees to set aside a predetermined amount of money from their pay, not to exceed the maximum amount authorized by federal law, per calendar year, of before tax dollars, for health care expenses not reimbursed by any other health benefit plans. HCSA dollars may be expended on any eligible medical expenses allowed by Internal Revenue Code Section 125. Any unused balance is forfeited and cannot be recovered by the employee.

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