Individual Faculty Member Rights
Individual Faculty Member Rights Sample Clauses
Related to Individual Faculty Member Rights
Member Rights The Subscriber Agreement (SA) shall include a complete statement that a Member shall have the right to: Available and accessible services when medically necessary, 24 hours per day, 7 days per week for Urgent or Emergency Health Care Services, and for other Health Care Services as defined by the Agreement; Be treated with courtesy and consideration, and with respect for the Covered Person's dignity and need for privacy; Be provided with information concerning our policies and procedures regarding products, services, Providers, Appeals procedures and other information about Presbyterian Health Plan; To choose a Primary Care Practitioner within the limits of the Covered Benefits, plan network, and as provided by this rule, including the right to refuse care of specific Health Care Professionals; Receive from the Covered Person's Physician(s) or Provider, in terms that the Covered Person understands, an explanation of his or her complete medical condition, recommended treatment, risk(s) of the treatment, expected results and reasonable medical alternatives, irrespective of our position on treatment options; if the Covered Person is not capable of understanding the information, the explanation shall be provided to his or her next of kin, guardian, agent or surrogate, if available, and documented in the Covered Person's medical record; All the rights afforded by law, rule, or regulation as a patient in a licensed Health Care Facility, including the right to refuse medication and treatment after possible consequences of this decision have been explained in language the Covered Person understands; Prompt notification, as required in this rule, of termination or changes in benefits, services or Practitioner/Provider network; File a Complaint or Appeal with us or the Superintendent and to receive an answer to those Complaints in accordance with existing law; Privacy of medical and financial records maintained by us and our Health Care Providers, in accordance with existing law; Know upon request of any financial arrangements or provisions between Presbyterian Health Plan and our Practitioners/Providers which may restrict referral or treatment options or limit the services offered to Covered Persons; Adequate access to qualified Health Professionals for the treatment of Covered Benefits near where the Covered Person lives or works within our Service Area; To the extent available and applicable to us, to affordable health care, with limits on Out-of-pocket expenses, including the right to seek care from a non-participating (Out-of-network) Provider, and an explanation of a Covered Person's financial responsibility when services are provided by a non- participating (Out-of-network) Provider, or provided without required Prior Authorization; An approved example of the financial responsibility incurred by a Covered Person when going Out-of-network; inclusion of the entire “billing examples” provided by the Superintendent available on the Division's website at the time of the filing of the plan will be deemed satisfaction of this requirement; any substitution for, or changes to, the Division's “billing examples” requires written approval by the Superintendent, in our Health Care Benefit Plan that provides benefits for Out-of-network Coverage; Detailed information about Coverage, Maximum Benefits, and Exclusions of specific conditions, ailments or disorders, including restricted Prescription benefits, and all requirements that a Covered Person must follow for Prior Authorization and Utilization Review; A complete explanation of why care is denied, an opportunity to Appeal the decision to our internal review, the right to a secondary Appeal, and the right to request the Superintendent’s assistance.
Spouse The spouse of an eligible employee (if legally married under Minnesota law). For the purposes of health insurance coverage, if that spouse works full-time for an organization employing more than one hundred (100) people and elects to receive either credits or cash (1) in place of health insurance or health coverage or (2) in addition to a health plan with a seven hundred and fifty dollar ($750) or greater deductible through his/her employing organization, he/she is not eligible to be a covered dependent for the purposes of this Article. If both spouses work for the State or another organization participating in the State's Group Insurance Program, neither spouse may be covered as a dependent by the other, unless one spouse is not eligible for a full Employer Contribution as defined in Section 3A. Effective January 1, 2015 if both spouses work for the State or another organization participating in the State’s Group Insurance Program, a spouse may be covered as a dependent by the other.
Part-Time Unit Members Unit members who are employed half-time or more for a period of nine (9) or more consecutive calendar months in the school year may choose to accept one or more of these benefits and shall only be entitled to the percentage of District contribution for the plan in which they are enrolled in the same ratio as their actual service assignment bears to a full-time assignment, the unit member share to be paid in advance by personal payroll deduction.
New Members No person may be admitted as a member of the Company without the approval of the Member.
New Member Orientation The Employer will notify the Union of any newly represented temporary employees. The Union will be given the opportunity to have a Union representative speak with the newly represented temporary employees for not more than thirty (30) minutes to provide information about the Union and this Agreement.
