Payment by Members Sample Clauses
The 'Payment by Members' clause establishes the obligation of members to make specified payments to the organization or entity, typically as part of their membership requirements. This clause outlines the types of payments required, such as membership fees, dues, or special assessments, and may detail the timing, method, and conditions for these payments. By clearly defining payment responsibilities, this clause ensures the organization has a reliable source of funding and helps prevent disputes over financial obligations among members.
Payment by Members. Except as provided in Section 8.1.23.1, MCOs, Network Providers, and Out-of-Network Providers are prohibited from billing or collecting any amount from a Member for Covered Services. MCOs must inform Members of their responsibility to pay the costs for non-covered services, and must require its Network Providers to:
Payment by Members. (a) Medicaid and CHIP HMOs STAR and STAR+PLUS HMOs, Network Providers, and Out-of-Network Providers are prohibited from billing or collecting any amount from a Member for Covered Services. This prohibition also applies to CHIP and CHIP Perinatal HMOs, Network Providers, and Out-of-Network Providers, except that CHIP Network Providers and Out-of-Network Providers may collect copayments authorized in the CHIP State Plan from CHIP Members for Covered Services. STAR, STAR+PLUS, CHIP, and CHIP Perinatal HMOs must inform Members of costs for non-covered services, and must require its Network Providers to:
(1) inform Members of costs for non-covered services prior to rendering such services; and
(2) obtain a signed Private Pay form from such Members.
Payment by Members. (a) Medicaid HMOs Medicaid HMOs and their Network Providers are prohibited from billing or collecting any amount from a Member for Health Care Services covered by this Contract. HMO must inform Members of costs for non-covered services, and must require its Network Providers to:
(1) inform Members of costs for non-covered services prior to rendering such services; and
(2) obtain a signed Private Pay form from such Members.
Payment by Members. (a) Medicaid HMOs Medicaid HMOs and their Network Providers are prohibited from billing or collecting any amount from a Member for Health Care Services covered by this Contract. HMO must inform Members of costs for non-covered services, and must require its Network Providers to:
(1) inform Members of costs for non-covered services prior to rendering such services; and
(2) obtain a signed Private Pay form from such Members.
(b) CHIP HMOs.
(1) Families that meet the enrollment period cost share limit requirement must report it to the HHSC Administrative Services Contractor. The HHSC Administrative Service Contractor notifies the HMO that a family’s cost share limit has been reached. Upon notification from the HHSC Administrative Services Contractor that a family has reached its cost-sharing limit for the term of coverage, the HMO will generate and mail to the CHIP Member a new Member ID card within five days, showing that the CHIP Member’s cost-sharing obligation for that term of coverage has been met. No cost-sharing may be collected from these CHIP Members for the balance of their term of coverage.
(2) Providers are responsible for collecting all CHIP Member co-payments at the time of service. Co-payments that families must pay vary according to their income level.
(3) Co-payments do not apply, at any income level, to Covered Services that qualify as well-baby and well-child care services, as defined by 42 C.F.R. §457.520.
(4) Except for costs associated with unauthorized non-emergency services provided to a Member by Out-of-Network providers and for non-covered services, the co-payments outlined in the CHIP Cost Sharing Table in the HHSC Uniform Managed Care Manual are the only amounts that a provider may collect from a CHIP-eligible family. As required by 42 C.F.R. §457.515, this includes, without limitation, Emergency Services that are provided at an Out-of-Network facility. Cost sharing for such Emergency Services is limited to the co-payment amounts set forth in the CHIP Cost Sharing Table.
(5) Federal law prohibits charging premiums, deductibles, coinsurance, co-payments, or any other cost-sharing to CHIP Members of Native Americans or Alaskan Natives. The HHSC Administrative Services Contractor will notify the HMO of CHIP Members who are not subject to cost-sharing requirements. The HMO is responsible for educating Providers regarding the cost-sharing waiver for this population.
(6) An HMO’s monthly Capitation Payment will not be reduced for a famil...
Payment by Members. Marketer shall ensure that each Member accessing product services from a service provider, within the ToolBox offered products, is aware of the Member‟s obligation to pay the service provider the negotiated rates for the product services at the time the Member is accessing such product services.
Payment by Members. (a) The Dental Contractor, Network Providers, and Out-of-Network Providers are prohibited from billing or collecting any amount from a Member for Covered Services, except that CHIP Network Providers and Out-of-Network Providers may collect copayments authorized in the CHIP State Plan from CHIP Members for Covered Services.
(b) The Dental Contractor must inform Members of costs for non-covered services, and must require its Network Providers to:
(1) inform Members of costs for non-covered services prior to rendering such services; and
(2) obtain a signed Private Pay form from such Members.
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Payment by Members