Payments from Enrollees Sample Clauses

Payments from Enrollees. Enrollees utilizing medical services which are not medically necessary or who obtain Covered Services from Outside Providers without prior authorization and referral by the Contractor shall be responsible for payment in full of all costs associated with such services. The Contractor shall not require any co-payments, deductibles or other cost sharing by Enrollees for Covered Services under this Contract, nor may the Contractor charge Enrollees for missed appointments. Neither shall Enrollees who are insured under private health plans be required to pay any portion of the medical fees for Covered Services under this contract, even during the deductible periods of these other health plans.
Sample 1Sample 2Sample 3See All (5)
AutoNDA by SimpleDocs
Payments from Enrollees. The MCO shall not require co-payments, deductibles, or other forms of cost sharing from Medicaid Enrollees for Medicaid services covered under this Contract, nor shall MCO charge Enrollees for missed appointments. Enrollees who obtain services from Out-of-Network Providers without MCO authorization, except those services specified in Sections 6.3 and 6.18, shall be responsible for payment of costs associated with such services. As specified in 42 CFR 438.114(e), the MCO shall limit charges to enrollees for post-stabilization care services to an amount no greater than what the organization would charge the enrollee if he or she had obtained the services through MCO. Enrollees shall not be held liable for payments to Providers in the event that MCO or its subcontractors become insolvent or DMA does not pay MCO.
Sample 1
Payments from Enrollees. Enrollees utilizing medical services which are not medically necessary or who obtain Covered Services from Outside Providers without prior authorization and referral by the Contractor shall be responsible for payment in full of all costs associated with such services. The Contractor shall not require any co-payments, deductibles or other cost sharing by Enrollees for Covered Services under this Contract, nor may the Contractor charge Enrollees for missed appointments. Neither shall Enrollees who are insured under private health plans be required to pay any portion of the medical fees for Covered Services under this contract, even during the deductible periods of these other health plans. The Enrollee may be responsible for non-covered item(s) and/or service(s), only if, the provider ensures that written documentation in compliance with the Advance Beneficiary Notification (ABN) is received from the Enrollee that an item(s) or service(s) rendered is a non-covered item and/or service(s) and that the Enrollee will be financially responsible for the item(s) and/or service(s).
Sample 1
Payments from Enrollees. The LME shall not require co-payments, deductibles, or other forms of cost sharing from Medicaid Enrollees for Medicaid services covered under this Contract, nor shall the LME charge Enrollees for missed appointments. Enrollees who obtain services from Out-of-Network Providers without LME authorization, except those services specified in Sections 6.3 and 6.18, shall be responsible for payment of costs associated with such services. As specified in 42 CFR 438.114(e), the LME shall limit charges to enrollees for post-stabilization care services to an amount no greater than what the organization would charge the enrollee if he or she had obtained the services through the LME. Enrollees shall not be held liable for payments to Providers in the event that the LME or its subcontractors become insolvent or DMA does not pay the LME.
Sample 1

Related to Payments from Enrollees

  • When Must Distributions from a Xxxxxxxxx Education Savings Account Begin? Distribution of a Xxxxxxxxx Education Savings Account must be made (or otherwise will be deemed made) no later than 30 days from the earlier of the beneficiary’s death or attainment of age 30. A distribution from a Xxxxxxxxx Education Savings Account may be rolled over to another beneficiary’s Xxxxxxxxx Education Savings Account according to the requirements of Section (4). Note that the Economic Growth and Tax Relief Reconciliation Act of 2001 waives the distribution age limitation if the beneficiary of the Xxxxxxxxx Education Savings Account is a “Special Needs” student.

  • What Forms of Distribution Are Available from a Xxxxxxxxx Education Savings Account Distributions may be made as a lump sum of the entire account, or distributions of a portion of the account may be made as requested.

  • How Are Distributions from a Xxxxxxxxx Education Savings Account Taxed For Federal Income Tax Purposes? Amounts distributed are generally excludable from gross income if they do not exceed the beneficiary’s “qualified higher education expenses” for the year or are rolled over to another Xxxxxxxxx Education Savings Account according to the requirements of Section (4). “Qualified higher education expenses” generally include the cost of tuition, fees, books, supplies, and equipment for enrollment at (i) accredited post-secondary educational institutions offering credit toward a bachelor’s degree, an associate’s degree, a graduate-level or professional degree or another recognized post-secondary credential and (ii) certain vocational schools. In addition, room and board may be covered if the beneficiary is at least a “half-time” student. This amount may be reduced or eliminated by certain scholarships, qualified state tuition programs, HOPE, Lifetime Learning tax credits, proceeds of certain savings bonds, and other amounts paid on the beneficiary’s behalf as well as by any other deductions or credits taken for the same expenses. The definition of “qualified education expenses” includes expenses more frequently and directly related to elementary and secondary school education, including the purchase of computer technology or equipment or Internet access and related services. To the extent payments during the year exceed such amounts, they are partially taxable and partially non-taxable similar to payments received from an annuity. Any taxable portion of a distribution is generally subject to a 10% penalty tax in addition to income tax unless the distribution is (i) due to the death or disability of the beneficiary, (ii) made on account of a scholarship received by the beneficiary, or (iii) is made in a year in which the beneficiary elects the HOPE or Lifetime Learning credit and waives the exclusion from income of the Xxxxxxxxx Education Savings Account distribution. You may be allowed to take both the HOPE or Lifetime Learning credits while simultaneously taking distributions from Xxxxxxxxx Education Savings Accounts. However, you cannot claim a credit for the same educational expenses paid for through Xxxxxxxxx Education Savings Account distributions. To the extent a distribution is taxable, capital gains treatment does not apply to amounts distributed from the account. Similarly, the special five- and ten-year averaging rules for lump-sum distributions do not apply to distributions from a Xxxxxxxxx Education Savings Account. The taxable portion of any distribution is taxed as ordinary income. The IRS does not require withholding on distributions from Xxxxxxxxx Education Savings Accounts.

  • When Must Distributions from a Traditional IRA Begin You must begin receiving the assets in your account no later than April 1 following the calendar year in which you reach RMD age.

  • DEDUCTIONS FROM WAGES 3.01 Deductions from wages, approved by the Company, except those required by law, order-in-council, or Government regulations including union dues, shall be made only on written authorization signed by the employee.

  • When Must Distributions from a Xxxx XXX Begin Unlike Traditional IRAs, there is no requirement that you begin distribution of your account during your lifetime at any particular age.

  • DEDUCTIONS FROM PAY 24.01 The Employer shall continue to make necessary or approved deductions from an employee's pay for fringe benefits, taxes and other customary purposes and provide the employee with a statement of such deductions with each pay cheque.

  • Rollovers of Settlement Payments From Bankrupt Airlines If you are a qualified airline employee who has received a qualified airline settlement payment from a commercial airline carrier under the approval of an order of a federal bankruptcy court, you are allowed to roll over up to 90 percent of the proceeds to your Traditional IRA, within 180 days after receipt of such amount, or by a later date if extended by federal law. If you make such a rollover contribution, you may exclude the amount rolled over from your gross income in the taxable year in which the airline settlement payment was paid to you. If you are a qualified airline employee who has received a qualified airline settlement payment from a commercial airline carrier under the approval of an order of a federal bankruptcy court in a case filed after September 11, 2001, and before January 1, 2007, you are allowed to roll over any portion of the proceeds into your Xxxx XXX within 180 days after receipt of such amount, or by a later date if extended by federal law. For further detailed information and effective dates you may obtain IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs), from the IRS or refer to the IRS website at xxx.xxx.xxx.

  • Distribution of UDP and TCP queries DNS probes will send UDP or TCP “DNS test” approximating the distribution of these queries.

  • Overtime Pay Calculation Overtime shall not be claimed or received for less than fifteen (15) minutes. If overtime amounts to fifteen (15) minutes, or more, it shall be paid for the total period.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!