Other Situations. In the event that Section 8(a) is inapplicable, the Company shall also indemnify the Indemnitee unless, and except to the extent that, the Company shall prove by clear and convincing evidence in a forum listed in Section 8(c) below that the Indemnitee has not met the applicable standard of conduct required to entitle the Indemnitee to such indemnification.
Other Situations. Other types of Dependents allowed by law must be enrolled as required by law. You may contact Health Options Member Services or the Marketplace, as applicable, if you have questions. To obtain Dependent coverage under this section, you must submit a completed enrollment to Health Options or the Marketplace, as applicable, within 60 days after an event listed in this section. If you fail to submit a completed Application during the 60-day period as outlined above, your Dependent can be added during the annual Open Enrollment Period, or other special enrollment period required by law, by submitting a completed Application.
Other Situations. For all other situations not described above, the order of benefits will be determined in accordance with the Florida Law on Coordination of Benefits.
Other Situations a. We will be primary when any other provisions of state or federal law require us to be. When we are the primary plan, we will pay the benefits in accordance with the terms of your contract, just as if you had no other health care coverage under any other plan.
b. We will be secondary whenever the rules do not require us to be primary. When we are the secondary plan, we do not pay until after the primary plan has paid its benefits. We will then pay part or all of the allowable expenses left unpaid, as explained below. An “allowable expense” is a health care service or expense covered by one of the plans, including copayments, coinsurance and deductibles.
(1) If there is a difference between the amount the plans allow, we will base our payment on the higher amount. However, if the primary plan has a contract with the provider, our combined payments will not be more than the contract calls for. Health maintenanc e organizations (HMOs) and preferred provider organizations (PPOs) usually have contracts with their providers.
(2) We will determine our payment by subtracting the amount the primary plan paid from the amount we would have paid if we had been primary. We will use any savings to pay the balance of any unpaid allowable expenses covered by either plan.
(3) If the primary plan covers similar kinds of health care expenses, but allows expenses that we do not cover, we will pay for those items as long as there is a balance in your benefit reserve, as explained below.
(4) We will not pay an amount the primary plan did not cover because you did not follow its rules and procedures. For example, if your plan has reduced its benefit because you did not obtain pre-certification, as required by that plan, we will not pay the amount of the reduction, because it is not an allowable expense.
c. Benefit Reserve When we are secondary we often will pay less than we would have paid if we had been primary. Each time we "save" by paying less, we will put that savings into a benefit reserve. Each family member covered by this plan has a separate benefit reserve. We use the benefit reserve to pay allowable expenses that are covered only partially by both plans. To obtain a reimbursement, you must show us what the primary plan has paid so we can calculate the savings. To make sure you receive the full benefit or coordination, you should submit all claims to each of your plans. Savings can build up in your reserve for one year. At the end of the year any balance is erased, ...
Other Situations. We will be primary when any other provisions of state or federal law require us to be. When we are the primary plan, we will pay the benefits in accord with the terms of your contract, just as if you had no other health care coverage under any other plan. We will be secondary whenever the rules do not require us to be primary.
Other Situations. An employee should be provided a stipend when he/she is scheduled by supervision to continue to work for more than 2 hours past the regular mid-schedule meal period. • An employee should not be provided a stipend when he/she is provided a substantial meal (bag/box lunch, catered meal, etc.) and has supervisory approval to eat the meal and return to work without taking a meal period. However, the employee should be paid overtime for working during part of the meal period with prior supervisory approval. • When an employee attends training for which an overnight stay is required, the Company will provide a meal stipend for meals not provided for during the training. A meal stipend will not be provided to any employee for whom the Company provides a meal. During the 2014 negotiations, the Company and the Union agreed to memorialize the new Safety Shoe Policy rolled out earlier in the year, describing appropriate footwear to be worn by employees in certain departments as referenced below. The Company will provide an initial reimbursement for all newly eligible and subsequent new hires as described below for employees to purchase two (2) pairs of boots that meet the requirements for their position.
Other Situations. If there is no management plan for the affected eligible historic road, and not all the project activities are covered in Table J-1, then DOT&PF will review the road’s DOE to understand the road’s essential physical features (EPFs) and what aspects of integrity it retains. (Road features which were not identified as EPFs would not be addressed in the effects assessment.) The assessment of effect will consider the criteria under which the road has been determined significant— Criterion A, Criterion C, or both. Whether an undertaking’s effect on the historic road is adverse will be linked to the road’s significance as it relates to its EPFs. The assessment of effect would consider the scope and scale of the work in relation to the road’s significance and extent of EPFs. It is the intent of the signatories that the potential diminishment of qualities that make a road (or road segment) NRHP-eligible be understood as a flexible concept when the scope and scale of work, to be considered in project consultation, is modest.
Other Situations. Other types of Dependents allowed by law must be enrolled as required by law. You may contact Health Options Member Services or the SHOP, as applicable, if you have questions. To obtain Dependent coverage under this section, you must submit a completed enrollment to Health Options or the Marketplace, as applicable, within 60 days after an event listed in this section. If you fail to submit a completed enrollment during the 60-day period as outlined above, your Dependent can be added during the annual Open Enrollment Period, or other special enrollment period required by law, by submitting a completed Application. Additional information for Employer Groups enrolled through SHOP: You may add yourself and/or your Dependents if you select coverage through the SHOP within 60 days after the following events:
i. In the event of unintentional, inadvertent, or erroneous enrollment/non-enrollment caused by the SHOP or the U.S. Department of Health and Human Services;
ii. In the event that your insurance carrier providing coverage through the SHOP violates a material provision of your coverage contract;
iii. In the event you gain access to a new health insurance company through a SHOP because you make a permanent move;
iv. In the event you demonstrate exceptional circumstances to the SHOP; or
Other Situations. In all other instances, GeoTel will provide a solution to a reported GeoTel Program Error in the time frame reasonably determined by GeoTel. Where the resolution provided by GeoTel to either a Moderate Situation, or a Critical Situation that has been reduced to a Moderate Situation, is not permanent, then GeoTel shall provide a permanent solution as a part of the next Update or Release.
Other Situations. For all other situations not described above, the order of benefits will be determined in accordance with the Ohio Insurance Department rule on Coordination of Benefits.
