Requests for Eligibility Review Sample Clauses

Requests for Eligibility Review. ‌ If Insurer has reasonable cause to believe that an Enrollee is not eligible for the Program, (e.g., Insurer believes an Enrollee should be placed in a different state or federal program for which eligibility would render that Enrollee ineligible for the Program), Insurer shall provide a written eligibility review request to FHKC. Insurer’s written eligibility review request shall include: a. The reason for the eligibility review request; b. How the relevant considerations were discovered; c. Confirmation that no other considerations influenced Insurer’s decision to request the review, including (specifically, but without limitation): i. An adverse change in the Enrollee’s health status; ii. Utilization of services; iii. The Enrollee’s diminished mental capacity; or iv. Uncooperative or disruptive behavior resulting from the Enrollee’s special needs. FHKC shall review the eligibility request and provide its findings to Insurer, to the extent permitted by law. In the event Insurer disputes FHKC’s determination of a written eligibility request and the request is based upon the Enrollee’s eligibility for another state or federal program that would make the Enrollee ineligible for Florida Healthy Kids coverage, FHKC will seek an eligibility determination from the entity administering the federal or state program for which Insurer alleges the Enrollee is eligible. The Parties shall be bound by the entity’s response to the eligibility review request. The rights and remedies provided under this section are exclusive to such eligibility disputes.
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Requests for Eligibility Review. ‌ If Insurer has reasonable cause to believe that an Enrollee is not eligible for the Program, (for example, Insurer believes an Enrollee should be placed in a different state or federal program for which eligibility would render that Enrollee ineligible for the Program), Insurer shall provide a written eligibility review request to FHKC. Insurer’s written eligibility review request shall include:
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Related to Requests for Eligibility Review

  • Requests for Extension The Borrower may, by notice to the Administrative Agent (who shall promptly notify the Lenders) not earlier than 90 days and not later than 35 days prior to an anniversary of the Closing Date (each, an “Applicable Anniversary Date”), request that each Lender extend such Lender’s Maturity Date for an additional year from the Maturity Date then in effect for such Lender hereunder (such Lender’s “Existing Maturity Date”). The Borrower may request such an extension no more than two times.

  • Request for Review If any operator believes that in his case any requirment of a recognized agency is excessive, the operator may request the administrator, division of forestry, to review the requirements. If in the opinion of the administrator any or all are not necessary in the interest of public safety, he may make such changes as he considers advisable. Bucket: Metal, plastic, canvas, or fiberglass container capable of holding at least one gallon of water. Motorcycle helmets qualify. Campfire means a fire set for cooking, warming, or ceremonial purposes; not more than 3 feet in diameter or height; void of overhanging branches; with all combustible material cleared at least 1-1/2 times the diameter of the fire; or a barbecue in a noncombustible container.

  • Peer Review Dental Group, after consultation with the Joint ----------- Operations Committee, shall implement, regularly review, modify as necessary or appropriate and obtain the commitment of Providers to actively participate in peer review procedures for Providers. Dental Group shall assist Manager in the production of periodic reports describing the results of such procedures. Dental Group shall provide Manager with prompt notice of any information that raises a reasonable risk to the health and safety of Group Patients or Beneficiaries. In any event, after consultation with the Joint Operations Committee, Dental Group shall take such action as may be reasonably warranted under the facts and circumstances.

  • SALARY DETERMINATION FOR EMPLOYEES IN ADULT EDUCATION 1. The following shall apply to employees providing instruction in adult education programs in these districts: Continuing Education employees in the Adult Education High School Completion Program (credit courses) and Adult Education Academic Upgrading Programs (Adult Basic Education, General Education Development, Pre-General Education Development, Literacy and Adult Education English Language Programs). Employees teaching Adult Education academic programs including: High School Completion Program, Pathfinder High School Completion Program, Academic Business Education Program, General Equivalency Diploma Program, Adult Basic Education Program, Adult English as a Second Language Program, and Adult Special Education Program, in the Continuing Education Division.

  • Employment Eligibility Verification As required by IC § 22-5-1.7, the Contractor swears or affirms under the penalties of perjury that the Contractor does not knowingly employ an unauthorized alien. The Contractor further agrees that: A. The Contractor shall enroll in and verify the work eligibility status of all his/her/its newly hired employees through the E-Verify program as defined in IC § 22-5-1.7-3. The Contractor is not required to participate should the E-Verify program cease to exist. Additionally, the Contractor is not required to participate if the Contractor is self-employed and does not employ any employees. B. The Contractor shall not knowingly employ or contract with an unauthorized alien. The Contractor shall not retain an employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. C. The Contractor shall require his/her/its subcontractors, who perform work under this Contract, to certify to the Contractor that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The Contractor agrees to maintain this certification throughout the duration of the term of a contract with a subcontractor. The State may terminate for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the State.

  • Requests for Exclusion 9.1 The provisions of this section shall apply to any request by a Class Member for exclusion from the Class. 9.2 Any Class Member may make a request for exclusion by submitting such request in writing as set forth in the Notice. 9.3 Any request for exclusion must be submitted no later than the date specified in the Court’s preliminary approval order. 9.4 Any request for exclusion shall (i) state the Class Member’s full name and current address, (ii) provide the model year and Vehicle Identification Number (“VIN”) of his/her/its Class Vehicle(s) and the approximate date(s) of purchase or lease, and (iii) specifically and clearly state his/her/its desire to be excluded from the Settlement and from the Class. 9.5 Failure to comply with these requirements and to timely submit the request for exclusion will result in the Class Member being bound by the terms of the Settlement Agreement. 9.6 Any Class Member who submits a timely request for exclusion may not file an objection to the Settlement and shall be deemed to have waived any rights or benefits under this Settlement Agreement. 9.7 The Settlement Administrator shall report the names of all Class Members who have submitted a request for exclusion to the Parties on a weekly basis, beginning 30 days after the Notice Date. 9.8 Co-Lead Class Counsel represent and warrant that they have no other agreements with other counsel respecting Class Members, including any agreements with respect to referring, soliciting, or encouraging any Class Members to request to be excluded (or “opt out”) from this agreement. 9.9 Upon certification of the Class in connection with the Preliminary Approval of this agreement, Co-Lead Class Counsel agree to seek in the Preliminary Approval Order from the Court a provision encouraging all written communications to multiple Class Members with respect to this Agreement to be reviewed and approved by Co-Lead Class Counsel and the Court, and Co- Lead Class Counsel agree to abide by that provision as may be required by the Court.

  • Compensation Review The compensation of the Executive will be reviewed not less frequently than annually by the board of directors of the Company.

  • Log Reviews All systems processing and/or storing PHI COUNTY discloses to 11 CONTRACTOR or CONTRACTOR creates, receives, maintains, or transmits on behalf of COUNTY 12 must have a routine procedure in place to review system logs for unauthorized access.

  • Employee Eligibility Verification The Contractor warrants that it fully complies with all Federal and State statutes and regulations regarding the employment of aliens and others and that all its employees performing work under this Contract meet the citizenship or alien status requirement set forth in Federal statutes and regulations. The Contractor shall obtain, from all employees performing work hereunder, all verification and other documentation of employment eligibility status required by Federal or State statutes and regulations including, but not limited to, the Immigration Reform and Control Act of 1986, 8 U.S.C. §1324 et seq., as they currently exist and as they may be hereafter amended. The Contractor shall retain all such documentation for all covered employees for the period prescribed by the law. The Contractor shall indemnify, defend with counsel approved in writing by County, and hold harmless, the County, its agents, officers, and employees from employer sanctions and any other liability which may be assessed against the Contractor or the County or both in connection with any alleged violation of any Federal or State statutes or regulations pertaining to the eligibility for employment of any persons performing work under this Contract.

  • Request for Extension Upon request, the Department may extend the time allowed for both a response to the Letter of Concern and a Corrective Action Plan depending upon the nature of the deficiency. The Provider shall request an extension of time in writing from the Department’s designated representative. The written request shall contain a justification and proposed extension period.

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