REQUIREMENTS FOR HANDBOOK Sample Clauses

REQUIREMENTS FOR HANDBOOK. Contents a) General Overview (how the MMC or FHPlus product works) i) Explanation of the Contractor's MMC or FHPlus product, including what happens when an Eligible Person enrolls. ii) Explanation of the Contractor-issued Enrollee ED card, obtaining routine medical care, help by telephone, and general information pertaining to the Contractor's MMC or FHPlus product, i.e., location of the Contractor, providers, etc. iii) Invitation to attend scheduled orientation sessions and other educational and outreach activities.
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Related to REQUIREMENTS FOR HANDBOOK

  • Requirements for Protection In compliance with NPCC requirements and Good Utility Practice, Developer shall provide, install, own, and maintain relays, circuit breakers and all other devices necessary to remove any fault contribution of the Large Generating Facility to any short circuit occurring on the New York State Transmission System not otherwise isolated by Connecting Transmission Owner’s equipment, such that the removal of the fault contribution shall be coordinated with the protective requirements of the New York State Transmission System. Such protective equipment shall include, without limitation, a disconnecting device or switch with load- interrupting capability located between the Large Generating Facility and the New York State Transmission System at a site selected upon mutual agreement (not to be unreasonably withheld, conditioned or delayed) of the Developer and Connecting Transmission Owner. Developer shall be responsible for protection of the Large Generating Facility and Developer’s other equipment from such conditions as negative sequence currents, over- or under-frequency, sudden load rejection, over- or under-voltage, and generator loss-of-field. Developer shall be solely responsible to disconnect the Large Generating Facility and Developer’s other equipment if conditions on the New York State Transmission System could adversely affect the Large Generating Facility.

  • Member Handbook The Contractor shall develop a member handbook for its members. The Contractor’s member handbook shall be submitted annually for OMPP’s review. The member handbook shall include the Contractor’s contact information and Internet website address and describe the terms and nature of services offered by the Contractor, including the following information required under 42 CFR 438.10(f), which enumerates certain required information. The member handbook may be offered in an electronic format as long as the Contractor complies with 42 CFR 438.10(c)(6). The Hoosier Healthwise MCE Policies and Procedures Manual outlines the member handbook requirements. The Hoosier Healthwise member handbook shall include the following:  Contractor’s contact information (address, telephone number, TDD number, website address);  The amount, duration and scope of services and benefits available under the Contract in sufficient details to ensure that participants are informed of the services to which they are entitled, including, but not limited to the differences between the benefit options;  The procedures for obtaining benefits, including authorization requirements;  Contractor’s office hours and days, including the availability of a 24-hour Nurse Call Line;  Any restrictions on the member’s freedom of choice among network providers, as well as the extent to which members may obtain benefits, including family planning services, from out-of-network providers;  The extent to which, and how, after-hours and emergency coverage are provided, as well as other information required under 42 CFR 438.10(f), such as what constitutes an emergency;  The post-stabilization care services rules set forth in 42 CFR 422.113(c);  The extent to which, and how, urgent care services are provided;  Applicable policy on referrals for specialty care and other benefits not provided by the member’s PMP, if any;  Information about the availability of pharmacy services and how to access pharmacy services;  Member rights and protections, as enumerated in 42 CFR 438.100, which relates to enrollee rights. See Section 4.8 for further detail regarding member rights and protections;  Responsibilities of members;  Special benefit provisions (for example, co-payments, deductibles, limits or rejections of claims) that may apply to services obtained outside the Contractor’s network;  Procedures for obtaining out-of-network services;  Standards and expectations to receive preventive health services;  Policy on referrals to specialty care;  Procedures for notifying members affected by termination or change in any benefits, services or service delivery sites;  Procedures for appealing decisions adversely affecting members’ coverage, benefits or relationship with the Contractor;  Procedures for changing PMPs;  Standards and procedures for changing MCEs, and circumstances under which this is possible, including, but not limited to providing contact information and instructions for how to contact the enrollment broker to transfer MCEs due to one of the “for cause” reasons described in 42 CFR 438.56(d)(2)(iv), including, but not limited to, the following:  Receiving poor quality of care;  Failure to provide covered services;  Failure of the Contractor to comply with established standards of medical care administration;  Lack of access to providers experienced in dealing with the member’s health care needs;  Significant language or cultural barriers;  Corrective action levied against the Contractor by the office;  Limited access to a primary care clinic or other health services within reasonable proximity to a member’s residence;  A determination that another MCE’s formulary is more consistent with a new member’s existing health care needs;  Lack of access to medically necessary services covered under the Contractor’s contract with the State;  A service is not covered by the Contractor for moral or religious objections, as described in Section 6.3.3;  Related services are required to be performed at the same time and not all related services are available within the Contractor’s network, and the member’s provider determines that receiving the services separately will subject the member to unnecessary risk;  The member’s primary healthcare provider disenrolls from the member’s current MCE and reenrolls with another MCE; or  Other circumstances determined by the office or its designee to constitute poor quality of health care coverage.  The process for submitting disenrollment requests. This information shall include the following:  Hoosier Healthwise members may change MCEs after the first ninety (90) calendar days of enrollment only for cause;  Members are required to exhaust the MCE’s internal grievance and appeals process before requesting an MCE change ;  Members may submit requests to change MCEs to the Enrollment Broker verbally or in writing, after exhausting the MCE’s internal grievance and appeals process; and  The MCE shall provide the Enrollment Broker’s contact information and explain that the member must contact the Enrollment Broker with questions about the process. This information shall include how to obtain the Enrollment Broker’s standardized form for requesting an MCE change.  The process by which an American Indian/ Alaska Native member may elect to opt-out of managed care pursuant to 42 USC § 1396u–2(a)(2)(C) and transfer to fee-for-service benefits through the State;  Procedures for making complaints and recommending changes in policies and services;  Grievance, appeal and fair hearing procedures as required at 42 CFR 438.10(g)(2)(xi), including the following:  The right to file grievances and appeals;  The requirements and timeframes for filing a grievance or appeal;  The availability of assistance in the filing process;  The toll-free numbers that the member can use to file a grievance or appeal by phone;  The fact that, if requested by the member and under certain circumstances: (1) benefits will continue if the member files an appeal or requests a State fair hearing within the specified timeframes; and (2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member.  For a State hearing describe (i) the right to a hearing, (ii) the method for obtaining a hearing, and (iii) the rules that govern representation at the hearing.  Information about advance directives;  How to report a change in income, change in family size, etc.;  Information about the availability of the prior claims payment program for certain members and how to access the program administrator;  Information on alternative methods or formats of communication for visually and hearing-impaired and non-English speaking members and how members can access those methods or formats;  Information on how to contact the Enrollment Broker;  Statement that Contractor will provide information on the structure and operation of the health plan; and  In accordance with 42 CFR 438.10(f)(3), that upon request of the member, information on the Contractor’s provider incentive plans will be provided.

  • COMPLIANCE WITH POLICIES AND PROCEDURES During the period that Executive is employed with the Company hereunder, Executive shall adhere to the policies and standards of professionalism set forth in the policies and procedures of the Company and IAC as they may exist from time to time.

  • Certain State Law Requirements for Contracts The contents of this Section are required by Texas Law and are included by County regardless of content. For purposes of Sections 2252.152, 2271.002, and 2274.002, Texas Government Code, as amended, C&T hereby verifies that C&T and any parent company, wholly owned subsidiary, majority-owned subsidiary, and affiliate: a. Unless affirmatively declared by the United States government to be excluded from its federal sanctions regime relating to Sudan or Iran or any federal sanctions regime relating to a foreign terrorist organization, is not identified on a list prepared and maintained by the Texas Comptroller of Public Accounts under Sections 806.051, 807.051, or 2252.153 of the Texas Government Code. b. If employing ten (10) or more full-time employees and this Agreement has a value of

  • PROCUREMENT ETHICS Contractor understands that a person who is interested in any way in the sale of any supplies, services, construction, or insurance to the State of Utah is violating the law if the person gives or offers to give any compensation, gratuity, contribution, loan, reward, or any promise thereof to any person acting as a procurement officer on behalf of the State of Utah, or who in any official capacity participates in the procurement of such supplies, services, construction, or insurance, whether it is given for their own use or for the use or benefit of any other person or organization.

  • Rules, Regulations and Policies Employee shall abide by and comply with all of the rules, regulations, and policies of Employer, including without limitation Employer's policy of strict adherence to, and compliance with, any and all requirements of the banking, securities, and antitrust laws and regulations.

  • Policies and Procedures i) The policies and procedures of the designated employer apply to the employee while working at both sites. ii) Only the designated employer shall have exclusive authority over the employee in regard to discipline, reporting to the College of Nurses of Ontario and/or investigations of family/resident complaints. iii) The designated employer will ensure that the employee is covered by WSIB at all times, regardless of worksite, while in the employ of either home. iv) The designated employer will ensure that the employee is covered by liability insurance at all times, regardless of worksite, while in the employ of either home. v) The designated employer shall have exclusive authority over the employee’s personnel files and health records. These files will be maintained on the site of the designated employer.

  • Policies, Guidelines, Directives and Standards Either the Funder or the Ministry will give the HSP Notice of any amendments to the manuals, guidelines or policies identified in Schedule C. An amendment will be effective in accordance with the terms of the amendment. By signing a copy of this Agreement the HSP acknowledges that it has a copy of the documents identified in Schedule C.

  • Compliance with Rules and Policies The Executive shall perform all services in accordance with the lawful policies, procedures and rules established by the Company and the Board. In addition, the Executive shall comply with all laws, rules and regulations that are generally applicable to the Company or its subsidiaries and their respective employees, directors and officers.

  • Requirements for E- Bidders 3.1. For Individual/ Joint E-Bidders, the following documents shall be uploaded during online registration; 3.1.1. Copy of Identification Documents (both sides) 3.1.2. Evidence of deposit payment 3.2. For Agent acting for Individual/ Joint Online Bidders, the following documents shall be uploaded during online registration; 3.2.1. Copy of Identification Documents (both sides) of Individual/ Joint Online Bidder 3.2.2. Copy of Identification Documents (both sides) of Agent 3.2.3. Copy of letter of authorization to bid 3.2.4. Evidence of deposit payment 3.3. For Company, the following documents shall be uploaded during online registration: 3.3.1. Copy of Identification Documents (both sides) of the representative. 3.3.2. Copy of letter of authorization to bid under the Company’s Letter Head 3.3.3. Form 24; Form 44; Form 49 (or their equivalent forms under the Companies Act 2016)

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