Important Information - Please Read Carefully. The Medical Assistance Program, also known as Medicaid, is a governmental program to help people pay their medical bills. To be eligible, one must be financially unable to pay the cost of medically necessary care. Eligibility, therefore, has two tests: (1) financial eligibility; and (2) medical eligibility. Financial eligibility is determined by the local Department of Social Services. Medical eligibility is determined by the Medical Assistance Program. It is important to understand that even if you can no longer afford to pay for nursing facility care, Medical Assistance will not pay for nursing facility services unless you are also medically eligible for these services. You may obtain information regarding financial eligibility from the local Department of Social Services at no cost. If you want to know if you are medically eligible before you apply for Medicaid Assistance, for a nominal fee, you may obtain an assessment of your medical eligibility from the same contractor who currently functions as the State Review Agent for the Medical Assistance Program. To obtain an assessment of your potential medical eligibility, you may call the current State Review Agent, Xxxxxxxx, at 0-000-000-0000 or you may write to Delmarva at: Delmarva Attn: Xxxxxx Xxxxxxxx Delmarva Foundation 0000 Xxxxxxxxxxx Xxxx Easton, Maryland 21601 Medical conditions of nursing facility residents change over time. Therefore, the assessment you receive is advisory only and is not binding on the Medical Assistance Program. The assessment will, however, assist you in making an informed decision regarding your need for nursing facility care or for less intensive community based care. Community alternatives to nursing facility services are available. Information about community alternatives can be obtained from your Local Health Department, Geriatric Evaluations Services and from your local Area Agency on Aging Office. If you want additional information regarding Medical Assistance nursing facility benefits, please do not hesitate to call (000)000-0000 and ask for the Nursing Facility Program Specialist. Items and services not covered by Medicare or Medicaid and related charges are listed below. You may be charged for these items and services if the Resident or you (or the Resident's physician with the Resident's or your approval) ask for and receive them. The services marked with an (*) may have a separate supply charge. You will be notified of those charges at the time the supplies are or...
Important Information - Please Read Carefully. Use this Notice to inform the Committee that you are exercising your right to purchase shares of common stock ("Shares") of Warwick Community Bancorp, Inc. ("Company") pursuant to an option ("Option") granted under the Stock Option Plan of Warwick Community Bancorp, Inc. ("Plan"). If you are not the Participant, you must attach to this Notice a copy of the Beneficiary Designation Form executed by the Participant or other proof of your right to exercise the Option granted under the Stock Option Agreement entered into between the Company and the Participant ("Agreement"). To exercise the Option, this Notice should be completed and personally delivered or mailed by certified mail, return receipt requested, to: Warwick Community Bancorp, Inc., c/o The Warwick Savings Bank, 18 Oakland Avenue, Warwick, New York 10990-0591, Attention: Coxxxxxxx Xxxxxxxxx. Xxx xxxxxxxxx xxxx xx xxx xxercise of the Option shall be the earliest date practicable following the date this Notice is received by the Committee, but in no event more than three business days after the date this Notice is received by the Committee, subject to such rules and procedures as the Company may establish for "cashless exercises." Except as specifically provided to the contrary herein, capitalized terms shall have the meanings assigned to them under the Plan. This Notice is subject to all of the terms and conditions of the Plan and the Agreement.
Important Information - Please Read Carefully. The information provided in this Summary Disclosure Form is a guide to the attached Health Care Contract as defined in section 3963.01(H) of the Ohio Revised Code. The terms and conditions of the attached Health Care Contract constitute the contract rights of the parties. Reading this Summary Disclosure Form is not a substitute for reading the entire Health Care Contract. When you sign the Health Care Contract, you will be bound by its terms and conditions. These terms and conditions may be amended over time pursuant to section 3963.04 of the Ohio Revised Code. You are encouraged to read any proposed amendments that are sent to you after execution of the Health Care Contract. Nothing in this Summary Disclosure Form creates any additional rights or causes of action in favor of either party. The following documents are available on the Superior Dental Care website: xxx.xxxxxxxxxxxxxx.xxx • Summary Disclosure Form • Acceptance, Participation and Professional Review Procedures of Superior Dental Care, Inc • Fee Schedule • Claim Submission Guidelines • Evidence of Coverage and Plan Descriptions Dentist Participation Agreement This Agreement is dated as of , by and between Superior Dental Care, Inc., an Ohio corporation (“SDC”), and the undersigned dentist (the “Dentist”). SDC is a specialty health insuring corporation and enters into agreements with employers, other groups and administrators (“Subscribers”) to arrange for provision of Covered Dental Services to certain categories of individuals (“Covered Persons”) (such contracts referred to as “Subscriber Agreements”). SDC enters into agreements with dentists (“Participating Dentists”) to provide such dental services to Covered Persons. SDC and the Dentist hereby agree that the Dentist will serve as a Participating Dentist for the SDC Network. Dentist agrees to participate in the SDC Network on the terms and conditions set forth in this Agreement.
Important Information - Please Read Carefully. Reading this Summary Disclosure Form is not a substitute for reading the entire Health Care Contract. Pursuant to 25 C.R.S. §25-37-101(3)(b) the information provided in this Summary Disclosure Form is for informational purposes only, is meant only as a guide to the attached Health Care Contract, and shall not be deemed a term or a condition of the Health Care Contract. The terms and conditions of the Health Care Contract constitute the contract rights of the Parties. Nothing in this Summary Disclosure Form creates any additional rights or causes of action in favor of either Party.
Important Information - Please Read Carefully. The information provided in this Summary Disclosure Form is a guide to the attached Health Care Contract as defined in section 3963.01(H) of the Ohio Revised Code. The terms and conditions of the attached Health Care Contract constitute the contract rights of the Parties.
