Information Sharing (a) HHSC will provide the MA Dual SNP with resources regarding the LTSS covered by Medicaid in accordance with this section.
(b) Texas Medicaid benefits are described in Attachment B, Texas Medicaid Summary of Benefits. The MA Dual SNP must include the Texas Medicaid Summary of Benefits in its Member Handbook for the MA Product.
(c) HHSC and the MA Dual SNP will identify and share information, such as the following:
(1) HHSC will provide the MA Dual SNP with links to online Medicaid LTSS provider information for the traditional fee-for-service and STAR+PLUS programs. Within thirty (30) business days after receiving such information, the MA Dual SNP must post a link to this information on its website.
(2) The MA Dual SNP must:
A) Notify Dual Eligible Members and Other Dual SNP Members, via its member communication materials that information concerning Medicaid provider participation is available on the MA Dual SNP’s website; and
B) Notify Dual Eligible Members and Other Dual SNP Members that they may request written copies of Medicaid Provider directories by contacting their STAR+PLUS MCO,
C) Assist the Dual Eligible Members and Other Dual SNP Members in obtaining printed copies of Medicaid Provider directories from their STAR+PLUS MCO, and
D) Verify that the Dual Eligible Members and Other Dual SNP Member received the requested directory.
(3) The MA Dual SNP must notify Network Providers that information concerning Medicaid provider participation is available on the MA Dual SNP’s website. The MA Dual SNP must provide this notice in the Network Provider agreement, Network Provider manuals, bulletins, faxes, policies and procedures, provider manual updates, or other contractual documents.
(4) The MA Dual SNP must have written procedures for ensuring that Dual Eligible Members and Other Dual SNP Members have access to the services identified in the MA Product, including policies regarding network adequacy that are consistent with the requirements of the MA Agreement. The MA Dual SNP must provide HHSC with a copy of these policies no later than 5 business days after a request.
(d) The MA Dual SNP must encourage Network Provider SNF to electronically submit to the HHSC Medicaid claims administrator a resident transaction notice within 72 hours after a Dual Eligible Member’s admission or discharge from the nursing facility, in accordance with 40 Tex. Admin. Code § 19.2615.
(e) The MA Dual SNP is required to notify HHSC of significant changes to the terms of its CMS contract within 10 business days of such changes, which may include but is not limited to the following: changes in the services areas; plan benefit package (PBP) changes; non-renewal; terminations or deficiencies of the contract; notices of intent to deny; and any novation agreements. Plans must submit any CMS warning letters or corrective action plans within 10 business days of receipt to the HHSC point-of- contact identified in Section 9.06.
(f) The MA Dual SNP is required to notify HHSC in the event the Plan receives less than a 3.0 star Medicare rating on either its Part C or Part D scores. The Plan must provide an outline of the steps proposed or implemented to improve the low score.
(g) The MA Dual SNP must participate in meetings with HHSC, telephonic or in person, relating to the health care provided under this Agreement and their compliance with this Agreement's terms, and to timely provide any necessary information and data upon HHSC's request.
(h) The MA Dual SNP, upon request from HHSC, must provide all documents it provides to and receives from CMS, within 30 days of the HHSC request, unless an extension is granted by HHSC.
Health Care Insurance While a faculty member is on an approved leave of this type, the faculty member will be advised regarding the right to continue health care benefits in accordance with COBRA during the period of unpaid absence.
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.
HEALTH CARE PLANS Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.
HIPAA To the extent (if any) that DXC discloses “Protected Health Information” or “PHI” as defined in the HIPAA Privacy and Security Rules (45 CFR, Part 160-164) issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to Supplier or Supplier accesses, maintains, uses, or discloses PHI in connection with the performance of Services or functions under this Agreement, Supplier will: (a) not use or further disclose PHI other than as permitted or required by this Agreement or as required by law; (b) use appropriate safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement, including implementing requirements of the HIPAA Security Rule with regard to electronic PHI; (c) report to DXC any use or disclosure of PHI not provided for under this Agreement of which Supplier becomes aware, including breaches of unsecured protected health information as required by 45 CFR §164.410, (d) in accordance with 45 CFR §164.502(e)(1)(ii), ensure that any subcontractors or agents of Supplier that create, receive, maintain, or transmit PHI created, received, maintained or transmitted by Supplier on DXC’s behalf, agree to the same restrictions and conditions that apply to Supplier with respect of such PHI; (e) make available PHI in a Designated Record Set (if any is maintained by Supplier) in accordance with 45 CFR section 164.524;
Health Care Operations “Health Care Operations” shall have the same meaning as the term “health care operations” in 45 CFR §164.501.
Health Overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
Health Care Benefits A. Each regular, full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:
1. Blue Cross/Blue Shield of Michigan Flexible Blue 3 with Flexible Blue Rx Prescription Drug Coverage with a Health Savings Account (hereinafter collectively referred to as the “H.S.A Plan”). The Employer shall pay for the illustrated premium cost of this coverage and make an annual contribution to each participating employee’s Health Savings Account in the amount of $500 for those selecting single coverage and $1,000 for those selecting Employee & Spouse, Employee Child(ren) or Family coverage, or the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the lesser Employer contribution to the cost of such plan. Employees may, at their option, make additional contributions through bi-weekly pre-tax payroll deduction as permitted by applicable law.
2. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 3 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the greater employee contribution.
3. Blue Cross/Blue Shield of Michigan Community Blue PPO Option 6 Revised Plan with Blue Preferred Rx Prescription Drug Coverage with a 50% co-pay ($5 floor and a $50 ceiling). Employees shall pay the difference between the illustrated premium cost of this coverage and the amount of the Employer’s total contribution towards the cost of coverage under the H.S.A. Plan as described in Section 1 (a) (1), for the same level of benefit (i.e. single, employee/spouse, employee/child(ren) and family), or pay the difference between the total cost of such coverage and the maximum annual amount the Employer is permitted to pay under Section 3 of the Publicly Funded Health Insurance Contribution Act, Public Act 152 of the Michigan Public Acts of 2011, whichever results in the greater employee contribution.
(a) All coverage under any of the foregoing plans shall be subject to such terms, conditions, exclusions, limitations, deductibles, co-payments premium cost-sharing, and other provisions of the plans. Coverage shall commence on the employee’s ninetieth (90th) day of continuous employment. The employee’s contribution to the cost of such coverage shall be payable on a bi-weekly basis through automatic payroll deduction.
(b) To qualify for health care benefits as above described each employee must individually enroll and make proper application for such benefits at the Human Resources Department upon the commencement of his regular employment with the Employer.
(c) Except as otherwise provided under the Family and Medical Leave Act, when on an authorized unpaid leave of absence of more than two weeks, the employee will be responsible for paying all his benefit costs for the period he is not on the active payroll. Proper application and arrangements for the payment of such continued benefits must be made at the Human Resources Department prior to the commencement of the leave. If such application and arrangements are not made as herein described, the employee's health care benefits shall automatically terminate upon the effective date of the unpaid leave of absence.
(d) Except as otherwise provided under this Agreement and/or under COBRA, an employee's health care benefits shall terminate on the date the employee goes on a leave of absence for more than two weeks, terminates, retires or is laid off. Upon return from a leave of absence or layoff, an employee's health care benefits coverage shall be reinstated commencing with the employee's return.
(e) An employee who is on layoff or leave of absence for more than two weeks or who terminates may elect under COBRA to continue the coverage herein provided at his own expense.
(f) The Employer reserves the right to change a carrier(s), a plan(s), and/or the manner in which it provides the above benefits, provided that the benefits and conditions are equal to or better than the benefits and conditions outlined above.
(g) To be eligible for health care benefits as provided above, an employee must document all coverage available to him under his spouse's medical plan and cooperate in the coordination of coverage to limit the Employer's expense. If an employee’s spouse or eligible dependent children work for an employer who provides medical coverage, they are required to elect medical coverage with their employer, so long as the spouse’s or monthly contribution to the premium does not exceed 20% of the total premium cost of said coverage. The Monroe County Plan shall provide secondary coverage.
(h) Each employee is responsible for notifying the Human Resources Department of any change in his status, which might affect his insurance coverage or benefits, such as, marriage, divorce, births, adoptions, deaths, etc.
Long Term Care Insurance The University offers full-time faculty the opportunity to purchase Long-Term Care Insurance through a voluntary Long-Term Care Insurance policy. Faculty members are responsible for 100% of the premium, which may be remitted through payroll deduction.
Health Care Compliance Neither the Company nor any Affiliate has, prior to the Effective Time and in any material respect, violated any of the health care continuation requirements of COBRA, the requirements of FMLA, the requirements of the Health Insurance Portability and Accountability Act of 1996, the requirements of the Women's Health and Cancer Rights Act of 1998, the requirements of the Newborns' and Mothers' Health Protection Act of 1996, or any amendment to each such act, or any similar provisions of state law applicable to its Employees.
