Pregnant Members and Infants Sample Clauses

Pregnant Members and Infants. (1) The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. (2) In the event the HMO remains unaware of a Member’s pregnancy until delivery, the delivery will be covered by CHIP. Babies are automatically enrolled in the mother’s CHIP health plan at birth with CHIP eligibility and re-enrollment following the timeframe as that of the mother. The HHSC Administrative Services Contractor will then set the Member’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the Member’s original eligibility expiration date. Section 5.04.1 CHIP Perinatal eligibility, enrollment, and disenrollment (a) The HHSC Administrative Contractor will electronically transmit to the HMO new CHIP Perinate Member information based on the appropriate CHIP Perinate or CHIP Perinate Newborn Rate Cell. There is no waiting period for CHIP Perinatal Program Members. (b) CHIP Perinate Newborns are eligible for 12 months continuous enrollment, beginning with the month of enrollment as a CHIP Perinate (month of enrollment plus 11 months). A CHIP Perinate Newborn will maintain coverage in his or her CHIP Perinatal health plan.
Sample 1Sample 2Sample 3See All (18)
AutoNDA by SimpleDocs
Pregnant Members and Infants. (1) The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. (2) In the event the HMO remains unaware of a Member’s pregnancy until delivery, the delivery will be covered by CHIP. Babies are automatically enrolled in the mother’s CHIP health plan at birth with CHIP eligibility and re-enrollment following the timeframe as that of the mother. The HHSC Administrative Services Contractor will then set the Member’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the Member’s original eligibility expiration date.
Sample 1Sample 2
Pregnant Members and Infants. CONTRACTOR, through electronic means, or the providers, through calls to the provider hotline, will notify the Administrative Services Contractor when a pregnancy is diagnosed. Pregnant members, with the exception of Legal Permanent Residents and other legally qualified aliens who are not barred from Medicaid due to federal eligibility restrictions, will be referred to Medicaid for eligibility determination. Those members who are determined to be Medicaid eligible will be disenrolled from the CONTRACTOR. Medicaid coverage will be coordinated to begin immediately after CHIP eligibility ends so that there is no gap in health care coverage. In the event the CONTRACTOR remains unaware of a member’s pregnancy until delivery, the delivery will be covered by CHIP. The Administrative Services Contractor will suspend the Member’s eligibility expiration date after notification of the delivery is received. The Administrative Services Contractor will unsuspend the mother’s eligibility expiration date and set the mother’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the date when the mother’s eligibility would have expired if it had not been suspended during her pregnancy. To further ensure the reliability of the data, families also will be encouraged to notify the Administrative Services Contractor by phone or in writing when delivery of a baby to a CHIP-enrolled Member occurs. Most newborns born to CHIP members or CHIP heads of household will be Medicaid eligible. Eligibility of newborns must be determined for CHIP before enrollment can occur. The CHIP Administrative Services Contractor should be notified as soon after delivery as possible. For newborns determined to be CHIP-eligible, the baby will be covered from the beginning of the month of birth.
Sample 1
Pregnant Members and Infants. If notified of a CHIP Member's pregnancy prior to birth, the HHSC Administrative Contractor will refer pregnant CHIP Member to Medicaid for eligibility determination (with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions). Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage.
Sample 1
Pregnant Members and Infants. Becoming pregnant, in and of itself, does not make a Member ineligible for CHIP. If, after becoming pregnant, a Member chooses to apply for Medicaid and is determined to be Medicaid-eligible, she is no longer eligible for CHIP. The Administrative Services Contractor will notify the Member about her potential Medicaid eligibility and of her ability to apply for Medicaid and will provide appropriate resource information. Infants are automatically enrolled in the mother's CHIP health plan at birth with CHIP eligibility and reenrollment following the same time frame as those of the mother. CONTRACTOR through electronic means or the providers through calls to the provider hotline will notify the Administrative Services Contractor when a pregnancy is diagnosed. The administrative services contractor will deem the pregnant Member to be eligible for CHIP services under a new period of continuous coverage. The coverage will extend from the date of notification of the pregnancy through the later of: (1) the last day of the second month following the month of the baby's birth, or (2) the date when the mother's eligibility would have expired under the original twelve-month period of continuous coverage. To further ensure the reliability of the data, families also will be encouraged to notify the Administrative Services Contractor by phone or in writing when delivery of a baby to a CHIP-enrolled Member occurs.
Sample 1
Pregnant Members and Infants. The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. In the event the HMO remains unaware of a Member’s pregnancy until delivery, the delivery will be covered by CHIP. The HHSC Administrative Services Contractor will then set the Member’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the Member’s original eligibility expiration date. Most newborns born to CHIP Members or CHIP heads of household will be Medicaid eligible. Eligibility of newborns must be determined for CHIP before enrollment can occur. For newborns determined to be CHIP-eligible, the baby will be covered from the beginning of the month of birth for the period of time specified in the evidence of coverage.
Sample 1
Pregnant Members and Infants. (1) The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. (2) In the event the HMO remains unaware of a Member’s pregnancy until delivery, the delivery will be covered by CHIP. Babies are automatically enrolled in the mother’s CHIP health plan at birth with CHIP eligibility and re-enrollment following the timeframe as that of the mother. The HHSC Administrative Services Contractor will then set the Member’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the Member’s original eligibility expiration date. Section 5.04.1 CHIP Perinatal eligibility, enrollment, and disenrollment (a) The HHSC Administrative Contractor will electronically transmit to the HMO new CHIP Perinate Member information based on the appropriate CHIP Perinate or CHIP Perinate Newborn Rate Cell. There is no waiting period for CHIP Perinatal Program Members. (b) A CHIP Perinate born on or after September 1, 2010, and who lives in a family with an income at or below 185% of the FPL will be deemed eligible for 12 months of continuous Medicaid coverage (beginning on the date of birth). A CHIP Perinate will continue to receive coverage through the CHIP Perinatal Program as a “CHIP Perinate Newborn” if: (1) born before September 1, 2010, and (2) if born on or after September 1, 2010, to a family with an income above 185% to 200% FPL. A CHIP Perinate Newborn is eligible for 12 months continuous enrollment, beginning with the month of enrollment as a CHIP Perinate (month of enrollment plus 11 months). A CHIP Perinate Newborn will maintain coverage in his or her CHIP Perinatal health plan.
Sample 1
AutoNDA by SimpleDocs
Pregnant Members and Infants. The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from MCO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage.
Sample 1

Related to Pregnant Members and Infants

  • – ORIENTATION AND IN SERVICE 20.01 An orientation and in service program will be provided to all employees. These programs shall be reviewed and discussed from time to time by members of the Union-Management Committee. 20.02 A newly employed employee shall not be placed in charge, until she has been fully oriented to the home. 20.03 The following minimums shall be observed in the orientation/familiarization of a newly hired employee: (a) She is to be familiarized with the physical aspects of the building, the applicable policies and procedures of the Employer, and the daily routine of employees in the Home. (b) The period of orientation/familiarization shall be for a minimum of five (5) days or such greater period that the Employer deems necessary. (c) She shall be an additional employee to the usual staffing pattern. (d) The employee or employees involved in the orientation/familiarization will confirm that it has been completed, and this will be noted on the newly hired employee's personnel file, which will be reviewed with such employee, and the employee shall also be able to comment. (e) The employee may request up to three (3) additional days of paid orientation. When making her request, the employee will specify her learning needs and discuss with the Director of Care the development of the orientation learning plan. This request will not be unreasonably denied. (f) Notwithstanding the above, orientation/familiarization when an employee is transferred to a new unit/shift will be provided as required. (g) The Employer may, at its discretion, provide orientation in other circumstances. 20.04 Both the Employer and the Union recognize the joint responsibility and commitment to provide, and participate in, in-service education. The Union supports the principle of its members' responsibility for their own professional development and the Employer will endeavour to provide programmes related to the requirements of the Home. Programmes will be publicized and related material will be made readily accessible to staff in a timely manner. Any problems in accessing this information will be reported to the Union- Management Committee for resolution. (a) When an employee is required by the Employer to attend any in-service program or e-learning within the Home during her or his regularly scheduled working hours the employee shall suffer no loss of regular pay. (b) When an employee is required by the Employer to prepare for in service or to attend meetings, in service and other work related functions outside her regularly scheduled working hours, and the employee does attend same, she shall be paid for all time spent on such attendance at her regular straight time hourly rate of pay or at the employee's option, she shall receive equivalent time off. When an employee is required by the Employer to complete an e-learning programme outside her regularly scheduled working hours, she shall be paid for all time spent completing such learning at her regular straight time hourly rate of pay or at the employee's option, she shall receive equivalent time off. Part-time employees will be credited with seniority and service for all such hours paid as provided above while in attendance at in-services, meetings, and completing e-learning. (c) The Employer will endeavour where practical to schedule in-services at times which will facilitate the attendance of employees working outside the day shift. 20.06 When required by a certifying body to update an employee's qualifications, except where this matter is covered by another provision of the collective agreement, the Employer shall grant leave of absence without pay which shall include the time required to write any examinations. 20.07 The Employer undertakes to notify the Union in advance, so far as practicable, of any technological changes which the Employer has decided to introduce which will significantly change the employment status of the employee(s) within the bargaining unit. The Employer agrees to discuss with the Union the effect of such technological changes on the employment status of the employee(s) and to consider practical ways and means of minimizing the adverse effect, if any, on the employee(s) concerned. Employees who are subject to layoff due to technological change will then be given notice of such layoff at the earliest reasonable time and in keeping with the requirements of the applicable legislation and the provisions of Article 9.11 to

  • Orientation and In-Service Program The Hospital recognizes the need for a Hospital Orientation Program of such duration as it may deem appropriate taking into consideration the needs of the Hospital and the nurses involved.

  • Maintaining Eligibility for Employer Contribution The employer's contribution continues as long as the employee remains on the payroll in an insurance eligible position. Employees who complete their regular school year assignment shall receive coverage through August 31.

  • Employee Orientation Each and every person working for a contractor, including sub- contractors, will be given an orientation to familiarize them with the site safety program. Unless otherwise specified, each sub-contractor is responsible for the orientation of their workers.

  • LAYOFFS AND RECALLS (a) Employees will be laid off in reverse order of seniority whenever there is a reduction of employees in the bargaining unit. The only exception to this provision is when the client requests in writing that a specific security guard be retained at their site. Guards can bump due to (1) loss of site, (2) being bumped by a senior guard, (3) client removal for non-disciplinary reasons, (4) return from approved leave of absence or (5) loss of position on a site. (b) The Company shall notify employees whose position is to be eliminated due to the loss of work at a specific site or the loss of the entire site at least five (5) working days prior to the effective date of termination of the position. Such employee will be entitled to bump junior employees at other sites in order to maintain employment and status. The company will meet with the affected employee and their Union representative as quickly as possible after notification in order to allow the employee to review options and make an informed decision where they wish to bump into. The parties will attempt to place the security guard into an alternate site where said guard will not lose any days of pay, but in no event, will the placement, or bumping take more than five (5) working days (no more than five (5) unpaid days). If an employee is not slotted into their new position within said five (5) working days, the company will provide payment in lieu of work. During the up to five (5) days waiting period, the employee will be entitled to be on top of the spare board list if they so desire. (c) The Company shall generally give notice of recall by registered mail to the last recorded address of the employee. The employee shall keep the Company informed of the employee's present address of location where he may be reached. The employee who fails to do so shall forfeit his right of recall. (d) If, within one (1) calendar day from the receipt of such notice, the employee accepts the recall, the job will be held open for one (1) calendar day from the day of the employee's acceptance. In the event that such recalled employee is employed elsewhere at the time of recall, the Company will hold the position vacant for two (2) weeks if the Company has received appropriate advance notice from its client. (e) In circumstances where the Company must fill vacant positions without delay, the Company shall give notice of recall by telephone until able to find a qualified employee who is prepared to report to work immediately. (f) If the employee declines the position, or fails to respond to the notice within one (1) calendar day from the date of receipt of the original notice, or fails to report to work within the time period outlined above, such employee shall be considered to have resigned and shall forfeit his recall rights. Should such employee be prevented from returning to work due to illness or accident he shall retain his recall rights and the Company shall be at liberty to recall another employee. The employee shall be required to show proof of such illness or accident.

  • LAYOFFS AND RECALL 16.01 It is not the intent of these lay-off and recall procedures to apply to the normal summer period. However, where known, recall dates of ten (10) month employees shall be indicated on the Separation Certificate issued by the Employer. 16.02 In the event of lay-off, employees shall be laid off in reverse order of their seniority provided that those persons retained have the necessary skills, qualifications, and ability to perform the duties of those jobs maintained. a) In order to minimize the potentially disruptive nature of an Educational Assistant lay-off during the school year, an Educational Assistant who has received a lay-off notice during the school year may elect to: i) Accept the lay-off and be recalled under the terms of the Collective Agreement or; ii) Displace the most junior permanent Educational Assistant in the Division. b) Where there are Educational Assistants who are on lay-off or who are laid off at the end of June, and there will not be sufficient positions in September for them all to be recalled, then the Employer will lay-off a sufficient number of the most junior Educational Assistants so as to enable the more senior Educational Assistants to be recalled in September. c) Educational Assistants who receive a lay-off notice must declare their intention to displace a junior Educational Assistant within the first five (5) working days of receipt of the lay-off notice. It is agreed between the parties that failure to do so will mean that the Educational Assistant accepts lay-off at the end of the notice period. 16.03 Employees shall be recalled in order of their seniority provided that the person recalled has the necessary skills, qualifications, and ability to perform the duties of the job. 16.04 New employees shall not be hired if there are employees on lay-off with the necessary skills, qualifications, and ability to perform the work. 16.05 In the event of lay-off, every employee affected shall be given four (4) weeks’ notice before the date on which she is to be laid off, and to the extent that such minimum notice is not given, the employee shall receive pay in lieu thereof. 16.06 Grievances concerning lay-offs and recalls shall be initiated at Step II of the grievance procedure. 16.07 Notwithstanding the provisions of Article 15.01, an Educational Assistant who normally works twenty-seven and one-half (27 ½) or more hours per week, and whose hours of work have been unilaterally reduced during the school year, shall, at the Educational Assistant’s option, be deemed to have been laid off. An Educational Assistant accepting a position having fewer hours than their normal working day will be given primary consideration upon application when new positions become available having comparable hours. 16.08 All Educational Assistants laid off shall be placed on a recall list, with copy furnished to the Union, and shall be called back to work as required beginning with the most senior Educational Assistant and descending from there. 16.09 No Educational Assistant shall be permitted to have her name remain on the recall list in excess of twelve (12) school months following the month in which the layoff occurred.

  • Labor Management Meetings Section 11.1. In the interest of sound labor/management relations, the parties agree to meet at agreeable dates and times for the purpose of discussing those issues outlined herein. Normally, meetings held pursuant to this Article will occur no more frequently than once every three (3) months, unless matters of an urgent nature require immediate attention. No more than three (3) employee representatives in pay status will attend such meetings. The Employer and OAPSE may have representatives as each deems necessary to address the issues. Section 11.2. The party requesting the meeting shall furnish an agenda and the names of the employees who will be attending, with the request for the meeting. Subjects that may be discussed at these meetings shall include but not be limited to the items listed below: A. Discuss the administration of this Agreement. B. Notify OAPSE of changes made by the Employer which may affect bargaining unit members. C. Discuss grievances which have not been processed beyond the final step of the Grievance Procedure when such discussions are mutually agreed to by the parties. D. Disseminate general information of interest to the parties. E. Give OAPSE representatives the opportunity to share the views of its members and/or make suggestions on subjects of interest to their members. F. Discuss ways to improve efficiency and work performance. Section 11.3. Written responses promised by either party shall be submitted to the other party within ten (10) work days after such meeting. Section 11.4. Labor/Management meetings are not intended to be negotiation sessions to alter or amend the basic agreement. Section 11.5. In the event of a change of duties of a position within the bargaining unit, or in the event that a new position is created within the Library, the Employer shall determine whether the new or changed position will be included in or excluded from the bargaining unit and shall so advise the Union in writing within thirty (30) calendar days. If the Union disputes the Employer's determination of bargaining unit status, the parties shall meet in an attempt to resolve their disagreement within seven (7) calendar days from the Union notification to the Employer. If the parties agree on the determination, it shall be implemented as agreed by the Employer and the Union and a joint petition for amendment of the bargaining unit shall be filed with the State Employment Relations Board (SERB). If the parties do not agree, the parties shall jointly petition SERB pursuant to Chapter 4117 of the Ohio Revised Code and the SERB Rules and Regulations for a determination of bargaining unit status.

  • PRE-JOB CONFERENCE a) The Employer shall notify the union that a project has been awarded to the Employer following the award. Prior to the start of each project, a pre-job conference shall be held to determine all site-specific issues as outlined in the Agreement. This conference may be conducted via telephone, through a scheduled meeting or by some other practical means as agreed to by the parties. b) A copy of the pre-job conference report shall be provided to the Employer, the Union and the Job Xxxxxxx (s). A copy shall also be posted on the bulletin board(s) at the jobsite.

  • Eligibility for Employer Contribution This section describes eligibility for an Employer Contribution toward the cost of coverage.

  • New Employee Orientation The Union will provide each agency personnel director with the names and addresses of up to two (2) authorized Union representatives per agency to receive notice of each formal orientation meeting held by the Department. The notice will be sent as soon as such meetings are scheduled (but not less than ten (10) days in advance) and will include date, time and location. Due to operational exigencies, agencies may schedule an orientation which will provide the Union with less than the requisite ten (10) days' notice; however the Union shall be notified as soon as possible after the scheduling of the orientation and the Union representative shall be released from duty. Agencies shall routinely schedule orientations in a manner that will allow for the ten (10) day advance notice to the Union. During the formal orientation, the Union will be permitted to give a twenty (20) minute presentation which may include an enrollment in supplemental Union benefits. The parties shall encourage employee attendance, although attendance shall not be mandatory if an employee objects to attending the presentation. In the event a formal orientation meeting is not held, or the Union is unable to attend the formal orientation because the designated Union representatives cannot be released under Article 4, the Employer shall allow the Union representative and the employee(s) to meet during duty hours at a mutually agreed upon time and location for twenty (20) minutes Employee participation in these meetings shall be encouraged although an employee shall not be required to attend such a meeting.

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