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Pre-Service Claim Sample Clauses

Pre-Service Claim. A pre-service claim is a claim that requires pre-approval as a condition of coverage. Approval or denial of an initial pre-service claim will be sent to a claimant within 15 calendar days after receipt of the claim, unless an extension is required. The 15-day period may be extended once up to 15 calendar days. A claimant will be notified of any such extension before the expiration of the initial 15 day period. If the extension is required due to a claimant's failure to provide the necessary information, the Claims Administrator will describe the required information. A claimant will have at least 45 calendar days from receipt of the notice to provide the information. If a claimant fails to follow the Plan's procedures for filing a pre-service claim, the Claims Administrator will notify such claimant of such failure no later than 5 days (24 hours if the pre-service claim also is an urgent care claim) following receipt of the claim. The preceding sentence only will apply in the case of a claim that (i) is received by the person responsible for handling benefit matters; and (ii) names a specific claimant, a specific medical condition or symptom and a specific treatment, service or product.
Pre-Service Claim. A Pre-Service Claim is a claim for benefits, that is filed before the medical services or treatment is provided.
Pre-Service ClaimThe Corporation will decide the appeal within a reasonable period of time, taking into account the circumstances, but no later than fifteen (15) days after receipt of the appeal. If the Member disagrees with the Corporation’s decision, the Member can submit a second appeal within ninety (90) days after receipt of the final decision of the first appeal. The Corporation will decide the second appeal within a reasonable period of time, taking into account the circumstances, but no later than fifteen (15) days after receipt of the second appeal.

Related to Pre-Service Claim

  • Vision Care Services For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.

  • Core Services The Company agrees to provide to the Municipality the Core Services set forth in Schedule “A”. The Company and the Municipality may amend Schedule “A” from time to time upon mutual agreement.

  • Future Services The Consultant acknowledges each of the following with regard to performing future services for the City: • The Consultant’s performance of the services required by this Agreement may create an actual or appearance of a conflict of interest with regard to the Consultant performing or participating in the performance of some related future services, particularly if the services required by this Agreement comprise one element or aspect of a multi-phase process or project; • Such an actual or appearance of a conflict of interest would be a ground for the City to disqualify the Consultant from performing or participating in the performance of such future services; and • The Consultant is solely responsible for considering what potential conflicts of interest, if any, performing the services required by this Agreement might have on its ability to obtain contracts to perform future services.

  • Claims Review The IRO shall perform the Claims Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Claims Review.

  • Group Grievance Where a number of employees have identical grievances and each employee would be entitled to grieve separately they may present a group grievance in writing signed by each employee who is grieving to the Administrator or her designate within ten (10) days after the circumstances giving rise to the grievance have occurred or ought reasonably to have come to the attention of the employee(s). The grievance shall then be treated as being initiated at Step No. 1 and the applicable provisions of this Article shall then apply with respect to the processing of such grievance.

  • Complaint Stage It is the mutual desire of the Parties that the complaints of employees shall be adjusted as quickly as possible. An employee who has a complaint must bring that complaint to the attention of the immediate Manager within five (5) working days of when the employee became or ought reasonably to have become aware of the occurrence that gave rise to the complaint. It is understood that no employee has a grievance until the immediate Manager has been given an opportunity to adjust the complaint and verbally reply, which shall be a maximum of three (3) working days from the presentation of the complaint.

  • Post Review With respect to each contract not governed by paragraph 2 of this Part, the procedures set forth in paragraph 4 of Appendix 1 to the Guidelines shall apply.

  • Trial Service Period An employee who has satisfactorily completed their probationary period and who is subsequently appointed to a position in another classification shall serve a twelve (12) month trial service period, in accordance with Section 10.1.3. 10.4.1 The trial service period shall provide the department with the opportunity to observe the employee's work and to train and aid the employee in adjustment to the position, and to revert such an employee whose work performance fails to meet required standards. 10.4.2 An employee who has been appointed from one classification to another classification within the same or different department and who fails to satisfactorily complete the trial service period shall be reverted to a vacant position within that department and classification from which the employee was appointed. 10.4.3 Where no such vacancy exists, such employee shall be given fifteen (15) calendar days' written notice prior to being placed on a Reversion Recall List for their former department and former classification and being removed from the payroll. 10.4.4 An employee’s trial service period may be extended up to three (3) additional months by written mutual agreement between the department, the employee and the Union, subject to approval by the Seattle Human Resources Director prior to expiration of the trial service period. 10.4.5 Employees who have been reverted during the trial service period shall not have the right to appeal the reversion. 10.4.6 The names of regular employees who have been reverted for purposes of re- employment in their former department shall be placed upon a Reversion Recall List for the same classification from which they were promoted or transferred for a period of one (1) year from the date of reversion. 10.4.7 If a vacancy is to be filled in a department and a valid Reversion Recall List for the classification for that vacancy contains the name(s) of eligible employees who have been removed from the payroll from that classification and from that department, such employees shall be reinstated in order of their length of service in that classification. The employee who has the most service in that classification shall be the first reinstated. 10.4.8 An employee whose name is on a Valid Reversion Recall List for a specific job classification who accepts employment with the City in that same job classification shall have their name removed from the Reversion Recall List. Refusal to accept placement from a Reversion Recall List to a position the same, or essentially the same, as that which the employee previously held shall cause an employee’s name to be removed from the Reversion Recall List, which shall terminate rights to reemployment under this Reversion Recall List provision. 10.4.9 An employee whose name is on a valid Reversion Recall List who accepts employment with the City in another class and/or department shall have their name removed from the Reversion Recall List. 10.4.10 A reverted employee shall be paid at the step of the range which the employee normally would have received had the employee not been appointed.

  • Litigation, etc The Fund shall give prompt notice in writing to the Purchaser of any litigation, administrative proceeding or business development which is reasonably expected to materially adversely affect its business, properties or affairs or to impair the ability of the Fund to perform its obligations as set forth hereunder or under any of the other Related Documents. All information, reports and other papers, documentation and data with respect to the Fund furnished to the Purchaser pursuant to this Section 6.9 shall be, at the time the same are so furnished, complete and correct in all material respects and, when considered with all other material delivered to the Purchaser under this Agreement or made available pursuant to the Due Diligence Request, will not contain untrue statements of material facts or omit to state material facts necessary to make the statements contained therein, in light of the circumstances under which they were made, not misleading.

  • Long Service Leave (1) Subject to subclause (3) of this clause, an employee who has completed ten years’ continuous service with the employer shall be entitled to (a) up to 31 December 2006, ten weeks’ long service leave (b) from 1 January 2007, thirteen weeks’ long service leave (c) For each subsequent period of ten years’ service an employee shall be entitled to an additional thirteen weeks’ long service leave. (2) An employee who has accrued a minimum entitlement of ten weeks’ long service leave shall be entitled to take such leave. (3) Employees are entitled to take long service leave in minimum periods of one week. (4) In calculating an employee’s entitlement under this clause, continuous service with the employer prior to the 1st day of January 1997 shall be taken into account in the following manner: (a) In the case of an employee who has already accrued an entitlement to long service leave with the employer prior to the 1st day of January, 1997, the employee shall continue to accrue subsequent entitlements to long service leave in accordance with the provisions of subclause (1) of this clause. (b) In the case of an employee who, at the 1st day of January 1997, had not accrued an entitlement to long service leave, the employee’s entitlement shall be calculated on the following basis: For any period of continuous employment prior to the 1st day of January 1997, an amount calculated on the basis of 13 weeks’ long service leave on full pay for each 15 years of continuous service, in accordance with the relevant award. (c) In the case of employees who have worked less than full-time during the accrual period, long service leave shall be paid at the rate of the average of hours worked over the accrual period. (5) The expression “continuous service” includes any period during which the employee is absent on full pay from their duties, but does not include: (a) Any period exceeding two weeks during which the employee is absent on leave without pay. In the case of leave without pay which exceeds eight weeks in a continuous period, the entire period of that leave is excised in full; (b) Any service of an employee who resigns or is dismissed, other than service prior to such resignation or prior to the date of any offence in respect of which they are dismissed by the employer, when that prior service has actually entitled the employee to long service leave under this clause. (6) Any entitlement to annual leave that falls due during the period of long service leave shall be recognised as extra leave and not included in the long service leave. (7) Any public holiday which occurs during the period an employee is on long service leave shall be treated as part of the long service leave and extra days in lieu thereof shall not be granted. (8) Where an employee has become entitled to a period of long service leave in accordance with this clause, the employee shall commence such leave as soon as possible after the accrual date, or in a manner mutually agreed between the employer and employee. (9) Payment for long service leave shall be made; (a) in full before the employee goes on leave, or (b) by the normal fortnightly payment intervals; (c) or by agreement between the employee and the employer. (10) Where an employee has completed at least 7 years’ service but less than 10 years’ service and employment is terminated- (a) by their death; (b) in any circumstances, other than serious misconduct, the amount of leave shall be such proportion to the number of completed years of such service bears to 10 years. (11) In the case to which subclause (8) of this clause applies and in any case in which the employment of the employee who has become entitled to leave hereunder is terminated before such leave is taken or fully taken the employer shall, upon termination of employment otherwise than by death, pay to the employee and upon termination by death, pay to the personal representative of the employee upon request by the personal representative, a sum equivalent to the amount which would have been payable in respect of the period of leave to which they are entitled or deemed to have been entitled and which would have been taken but for termination. Such payment shall be deemed to have satisfied the obligation of the employer in respect of leave hereunder. (12) Where an employee is ill during a period of long service leave and produces at the time, or as soon as practicable thereafter, medical evidence that would satisfy a reasonable person that as a result of illness or injury the employee was confined to their place of residence or a medical facility for a period of at least fourteen (14) consecutive days, the employer shall grant sick leave for the period the employee was so confined and reinstate long service leave equivalent to the period of confinement.