Preliminary Review Sample Clauses

Preliminary Review. Prior to issuing a disciplinary action of unpaid suspension, demotion, or discharge, the supervisor will make a recommendation to his/her supervisor regarding proposed discipline. That supervisor will then schedule a meeting with the employee prior to making a final determination of the proposed discipline. The employee shall have the opportunity to have union representation present and be provided the opportunity to speak on his/her behalf regarding the proposed action. If the employee is unable to meet with the supervisor, the employee will be given the opportunity to respond in writing.

Preliminary Review. Within five business days of receipt of the request from the Director, the Plan will complete a preliminary review of your request to determine whether:

Preliminary Review. Upon receipt of a request for standard external review, The Plan must complete a preliminary review within 5 business days to determine whether: a. The Member is or was covered under The Plan when the health care service or treatment was requested or, in the case of a retrospective review, whether the Member was covered under The Plan when the health care service or treatment was provided; b. The requested health care service or treatment that is the subject of the adverse benefit determination or final internal adverse benefit determination: (i) is a covered Benefit under the Member’s health plan except for The Plan’s determination that the health care service or treatment is experimental or investigational for a particular medical condition; and (ii) is not explicitly listed as an excluded Benefit under the Member’s health plan; c. The Member’s treating health care provider has certified that one of the following situations is applicable: (i) standard health care services or treatments have not been effective in improving the condition of the Member; (ii) standard health care services or treatments are not medically appropriate for the Member; or (iii) there is no available standard health care service or treatment covered by The Plan that is more beneficial than the requested health care service or treatment; (i) The Member’s treating health care provider has recommended a health care service or treatment that the Physician certifies, in writing, is likely to be more beneficial to the Member, in the Physician's opinion, than any available standard health care services or treatments; or (ii) a Physician who is licensed, board-certified, or eligible to take the examination to become board-certified and is qualified to practice in the area of medicine appropriate to treat the Member’s condition has certified in writing that scientifically valid studies using accepted protocols demonstrate that the health care service or treatment requested by the Member who is subject to the adverse benefit determination or final internal adverse benefit determination is likely to be more beneficial to the Member than any available standard health care services or treatments; and e. The Member has exhausted The Plan’s internal appeals process, or the Member is exempt from exhausting The Plan’s internal appeals process. Within 1 business day after completion of the preliminary review, The Plan will notify the Member or the Member’s authorized representative in writing as to...

Preliminary Review. Upon receipt of a request for an expedited external review, The Plan must immediately complete a preliminary review to determine whether the request is eligible for external review, considering the same preliminary review requirements set forth in the Preliminary Review paragraph, Standard External Review Procedures section, above. Immediately after completion of the preliminary review, The Plan will notify the Member or the Member’s authorized representative in writing as to whether the request is complete, and the request is eligible for external review. If the request is not complete, The Plan will inform the Member or the Member’s authorized representative in writing and include in the notice the information or materials that are needed to make the request complete. If the request is not eligible for external review, The Plan will inform the Member or the Member’s authorized representative in writing and include in the notice the reasons for the request's ineligibility. The notice of initial determination will include a statement informing the Member or the Member’s authorized representative of the right to appeal the determination of ineligibility to the Commissioner of Securities and Insurance. The notice will also provide contact information for the Commissioner’s office.

Preliminary Review. Upon receiving the Member’s request for expedited external review, The Plan will immediately determine whether the request is eligible for external review, considering the same preliminary review requirements set forth in the Preliminary Review paragraph, Standard External Review Procedures section. After the preliminary review is complete, The Plan will immediately notify the Member or the Member’s authorized representative in writing of its eligibility determination. If The Plan determines the Member’s request is ineligible for review, the notice must include a statement informing the Member or the Member’s authorized representative of the right to appeal The Plan’s determination to the Commissioner of Securities and Insurance. The notice must also provide contact information for the Commissioner’s office.

Preliminary Review. The Plan must complete a preliminary review within 5 business days from receipt of the Member’s request for a standard external review to determine whether: a. The Member is or was covered under The Plan when the health care item or service was requested or, in the case of a retrospective review, whether the Member was covered under The Plan when the health care item or service was provided; b. The adverse benefit determination or final internal adverse benefit determination relates to the Member’s failure to meet The Plan’s eligibility requirements; c. The Member has exhausted (or is not required to exhaust) The Plan’s internal appeals process; and/or d. The Member has provided all the information and forms required to process the external review. Within 1 day after completing its review, The Plan will notify the Member in writing if the request is eligible for external review. If further information or materials are necessary to complete the review, the written notice will describe the information or materials and the Member will be given the remainder of the 4-Month period or 48 hours after receipt of the written notice, whichever is later, to provide the necessary information or materials. If the request is not eligible for external review, The Plan will outline the reasons for ineligibility in the notice, include a statement informing the Member or the Member’s authorized representative of the right to appeal The Plan’s determination to the Commissioner of Securities and Insurance and provide the Member with contact information for the U.S. Employee Benefits Security Administration (toll-free number 0-000-000-XXXX (3272)) and contact information for the Commissioner’s office.

Preliminary Review. The Plan Administrator will perform a preliminary review of the domestic relations order to determine if it is a QDRO. If this preliminary review indicates the order is deficient in some manner, the Plan Administrator will allow the parties to attempt to correct any deficiency before issuing a final decision on the domestic relations order. The ability to correct is limited to a reasonable period of time.

Preliminary Review. Within five business days of receipt of the request from the IDOI, the Plan will complete a preliminary review of your re­ quest to determine whether:

Preliminary Review. For this paragraph’s purposes only, “Publication” does not mean a disclosure that reasonably has excluded detailed experimental results.

Preliminary Review a. A review that does not include external letters and is only conducted by the Department Evaluation Panel (as described below in Section 6.7(c)). b. Results of this review are provided directly to the Xxxxxxx for consideration.