Common use of Member Financial Liability Clause in Contracts

Member Financial Liability. The Contractor shall educate network Providers to collect Co-Payments from Members in accordance with Table 2. Per Emergency Room Visit None $15.00 $15.00 Out-of-Pocket Maximum N/A $800.00 $950.00 The Contractor shall track the amount of Co-Payments collected in a given calendar year. When a Member meets his or her Out-of-Pocket Maximum, the Contractor shall send a letter to the Member indicating that no further Co-Payments should be paid for the remainder of the State Fiscal Year. The Contractor shall include instructions in the letter to present the letter when future health services are sought, or request the Provider to contact the Contractor regarding this issue. The Contractor must submit the template letter to the Division thirty (30) calendar days prior to use for the Division review. No Cost Sharing may be collected from these CHIP Members for the balance of the State Fiscal Year. The Contractor shall comply with all Cost Sharing restrictions imposed on Members by Federal or State laws and regulations, including the following specific provisions: 1. The Contractor shall not apply Cost Sharing to the following services: preventive services, including immunizations, Well-Baby and Well-Child Care Services, routine preventive and diagnostic dental services, routine dental fillings, routine eye examinations, eyeglasses, and hearing aids in accordance with 42 C.F.R. § 457.520. 2. The Contractor shall not apply Cost Sharing to the costs of Emergency Services that are provided at a facility that does not participate in the Contractor's Provider Network beyond the Cost Sharing amounts specified in Table 2, in accordance with 42 C.F.R.§ 457.515(f). 3. Federal law prohibits charging premiums, deductibles, coinsurance, Co-Payments, or any other Cost Sharing to Native Americans or Alaskan Natives. The Contractor shall be responsible for educating network Providers regarding the waiver of Cost Sharing requirements for this population. 4. Members shall not be liable for payments to Providers for Covered Services provided other than the Co-Payments referenced within this Contract. 5. Providers may not xxxx a Member for Covered Services in the event the Contractor becomes insolvent. In addition, a Member who has an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or to stabilize the Member. The attending emergency physician, or the treating Provider, is responsible for determining when the Member is sufficiently stabilized for transfer or discharge, and that determination is binding on the Contractor for coverage and payment.

Member Financial Liability. The ‌ Contractor shall educate network Providers providers to collect Co-Payments from Members in accordance with Table 2. Per Physician Visit None $5.00 $5.00 Per Emergency Room Visit None $15.00 $15.00 Out-of-Pocket Maximum N/A None $800.00 $950.00 The Contractor shall track the amount of Co-Payments collected in a given calendar year. When a Member meets his or her Out-of-Pocket Maximum, the Contractor shall send a letter to the Member indicating that no further Co-Payments should be paid for the remainder of the State Fiscal Yearcalendar year. The Contractor shall include instructions in the letter to present the letter when future health services are sought, or request the Provider provider to contact the Contractor regarding this issue. The Contractor must submit the template letter to the Division DOM thirty (30) calendar days prior to use for the Division DOM review. No Cost Sharing may be collected from these CHIP Members for the balance of the State Fiscal Yearcalendar year. The Contractor shall comply with all Cost Sharing restrictions imposed on Members by Federal or State laws and regulations, including the following specific provisions: 1. The Contractor shall not apply Cost Sharing to the following services: preventive services, including immunizations, Well-Baby and Well-Child Care Services, routine preventive and diagnostic dental services, ; routine dental fillings, ; routine eye examinations, ; eyeglasses, ; and hearing aids in accordance with 42 C.F.R. § 457.520. 2. The Contractor shall not apply Cost Sharing to the costs of Emergency Services that are provided at a facility that does not participate in the Contractor's Provider Network beyond the Cost Sharing amounts specified in Table 2, in accordance with 42 C.F.R.§ C.F.R. § 457.515(f). 3. Federal law prohibits charging premiums, deductibles, coinsurance, Co-Payments, or any other Cost Sharing to Native Americans or Alaskan Natives. The Contractor shall be responsible for educating network Providers providers regarding the waiver of Cost Sharing requirements for this population. 4. Members shall not be liable for payments to Providers providers for Covered Services provided other than the Co-Payments referenced within this Contract. 5. Providers may not xxxx a Member for Covered Services in the event the Contractor CCO becomes insolvent. In addition, a Member who has an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or to stabilize the Member. The attending emergency physician, or the provider actually treating Providerthe Member, is responsible for determining when the Member is sufficiently stabilized for transfer or discharge, and that determination is binding on the Contractor for coverage and payment.

Member Financial Liability. ‌ The Contractor shall educate network Providers to collect Co-Payments from Members in accordance with Table 2. Per Emergency Room Visit None $15.00 $15.00 Out-of-Pocket Maximum N/A $800.00 $950.00 The Contractor shall track the amount of Co-Payments collected in a given calendar year. When a Member meets his or her Out-of-Pocket Maximum, the Contractor shall send a letter to the Member indicating that no further Co-Payments should be paid for the remainder of the State Fiscal Year. The Contractor shall include instructions in the letter to present the letter when future health services are sought, or request the Provider to contact the Contractor regarding this issue. The Contractor must submit the template letter to the Division thirty (30) calendar days prior to use for the Division review. No Cost Sharing may be collected from these CHIP Members for the balance of the State Fiscal Year. The Contractor shall comply with all Cost Sharing restrictions imposed on Members by Federal or State laws and regulations, including the following specific provisions: 1. The Contractor shall not apply Cost Sharing to the following services: preventive services, including immunizations, Well-Baby and Well-Child Care Services, routine preventive and diagnostic dental services, routine dental fillings, routine eye examinations, eyeglasses, and hearing aids in accordance with 42 C.F.R. § 457.520. 2. The Contractor shall not apply Cost Sharing to the costs of Emergency Services that are provided at a facility that does not participate in the Contractor's Provider Network beyond the Cost Sharing amounts specified in Table 2, in accordance with 42 C.F.R.§ 457.515(f). 3. Federal law prohibits charging premiums, deductibles, coinsurance, Co-Payments, or any other Cost Sharing to Native Americans or Alaskan Natives. The Contractor shall be responsible for educating network Providers regarding the waiver of Cost Sharing requirements for this population. 4. Members shall not be liable for payments to Providers for Covered Services provided other than the Co-Payments referenced within this Contract. 5. Providers may not xxxx a Member for Covered Services in the event the Contractor becomes insolvent. In addition, a Member who has an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or to stabilize the Member. The attending emergency physician, or the treating Provider, is responsible for determining when the Member is sufficiently stabilized for transfer or discharge, and that determination is binding on the Contractor for coverage and payment.

Member Financial Liability. The ‌ Contractor shall educate network Providers providers to collect Co-Payments from Members in accordance with Table 2. Per Emergency Room Visit None $15.00 $15.00 Out-of-Pocket Maximum N/A $800.00 $950.00 The Contractor shall track the amount of Co-Payments collected in a given calendar year. When a Member meets his or her Out-of-Pocket Maximum, the Contractor shall send a letter to the Member indicating that no further Co-Payments should be paid for the remainder of the State Fiscal Year. The Contractor shall include instructions in the letter to present the letter when future health services are sought, or request the Provider provider to contact the Contractor regarding this issue. The Contractor must submit the template letter to the Division DOM thirty (30) calendar days prior to use for the Division DOM review. No Cost Sharing may be collected from these CHIP Members for the balance of the State Fiscal Year. The Contractor shall comply with all Cost Sharing restrictions imposed on Members by Federal or State laws and regulations, including the following specific provisions: 1. The Contractor shall not apply Cost Sharing to the following services: preventive services, including immunizations, Well-Baby and Well-Child Care Services, routine preventive and diagnostic dental services, routine dental fillings, routine eye examinations, eyeglasses, and hearing aids in accordance with 42 C.F.R. § 457.520. 2. The Contractor shall not apply Cost Sharing to the costs of Emergency Services that are provided at a facility that does not participate in the Contractor's Provider Network beyond the Cost Sharing amounts specified in Table 2, in accordance with 42 C.F.R.§ C.F.R. § 457.515(f). 3. Federal law prohibits charging premiums, deductibles, coinsurance, Co-Payments, or any other Cost Sharing to Native Americans or Alaskan Natives. The Contractor shall be responsible for educating network Providers providers regarding the waiver of Cost Sharing requirements for this population. 4. Members shall not be liable for payments to Providers providers for Covered Services provided other than the Co-Payments referenced within this Contract. 5. Providers may not xxxx a Member for Covered Services in the event the Contractor CCO becomes insolvent. In addition, a Member who has an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or to stabilize the Member. The attending emergency physician, or the treating Providerprovider, is responsible for determining when the Member is sufficiently stabilized for transfer or discharge, and that determination is binding on the Contractor for coverage and payment.

Member Financial Liability. ‌ The Contractor shall educate network Providers to collect Co-Payments from Members in accordance with Table 2. Per Emergency Room Visit None $15.00 $15.00 Out-of-Pocket Maximum N/A $800.00 $950.00 The Contractor shall track the amount of Co-Payments collected in a given calendar year. When a Member meets his or her Out-of-Pocket Maximum, the Contractor shall send a letter to the Member indicating that no further Co-Payments should be paid for the remainder of the State Fiscal Year. The Contractor shall include instructions in the letter to present the letter when future health services are sought, or request the Provider to contact the Contractor regarding this issue. The Contractor must submit the template letter to the Division thirty (30) calendar days prior to use for the Division review. No Cost Sharing may be collected from these CHIP Members for the balance of the State Fiscal Year. The Contractor shall comply with all Cost Sharing restrictions imposed on Members by Federal or State laws and regulations, including the following specific provisions: 1. The Contractor shall not apply Cost Sharing to the following services: preventive services, including immunizations, Well-Baby and Well-Child Care Services, routine preventive and diagnostic dental services, routine dental fillings, routine eye examinations, eyeglasses, and hearing aids in accordance with 42 C.F.R. § 457.520. 2. The Contractor shall not apply Cost Sharing to the costs of Emergency Services that are provided at a facility that does not participate in the Contractor's Provider Network beyond the Cost Sharing amounts specified in Table 2, in accordance with 42 C.F.R.§ 457.515(f). 3. Federal law prohibits charging premiums, deductibles, coinsurance, Co-Payments, or any other Cost Sharing to Native Americans or Alaskan Natives. The Contractor shall be responsible for educating network Providers regarding the waiver of Cost Sharing requirements for this population. 4. Members shall not be liable for payments to Providers for Covered Services provided other than the Co-Payments referenced within this Contract. 5. Providers may not xxxx bill a Member for Covered Services in the event the Contractor becomes insolvent. In addition, a Member who has an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or to stabilize the Member. The attending emergency physician, or the treating Provider, is responsible for determining when the Member is sufficiently stabilized for transfer or discharge, and that determination is binding on the Contractor for coverage and payment.