Span of Coverage Sample Clauses

Span of Coverage. If a Member's effective date of coverage occurs while the Member is confined in a hospital, the CONTRACTOR is responsible for the Member's costs of Covered Services beginning on the Effective Date of Coverage. For each day that the Member is hospitalized beginning on the Effective Date of Coverage, HHSC will pay to CONTRACTOR $700 for non-ICU care and $1400 for ICU care. If a Member is disenrolled while the Member is confined in a hospital, CONTRACTOR's responsibility for the Member's costs of Covered Services terminates on the Date of Disenrollment. Six months after the Implementation Date, the Parties will review CONTRACTOR's data, and if either party believes that these payments are insufficient, either Party can instigate the Change Order process set out in Article 8. The Parties agree to negotiate any requested Change Order in good faith.
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Span of Coverage. (a) Medicaid HMOs. (1) Open Enrollment. HHSC will conduct continuous open enrollment for Medicaid Eligibles and the HMO must accept all persons who choose to enroll as Members in the HMO or who are assigned as Members in the HMO by HHSC, without regard to the Member’s health status or any other factor. (2) Enrollment of New Medicaid Eligibles. Persons who become eligible for Medicaid during an Inpatient Stay in a Hospital will not be enrolled in a Medicaid HMO until discharged from the Hospital, with the following exceptions: (1) Members retroactively enrolled in STAR in accordance with Section 5.03, “STAR Enrollment of Pregnant Women and Infants,” and (2) Members prospectively enrolled in STAR or STAR+PLUS who are at or below 12 months of age. Except as provided in the following table, if a Member is enrolled in a Medicaid HMO during an Inpatient Stay, the Medicaid HMO will be responsible for all Covered Services beginning on the Effective Date of Coverage. If a Member is enrolled during an Inpatient Stay under either of the above-referenced exceptions, responsibility for the Inpatient Stay services is assigned as follows: Member Retroactively Enrolled in STAR per Section 5.03 STAR HMO STAR HMO Member ≤ 12 Months of Age Who Is Prospectively Enrolled in STAR Medicaid FFS* STAR HMO Member ≤ 12 Months of Age Who Is Prospectively Enrolled in STAR+PLUS STAR+PLUS HMO for Inpatient Mental Health Covered Services Medicaid FFS for all Other Inpatient Facility Services* STAR+PLUS HMO *These services are Non-Capitated Services. (3) Movement between STAR or STAR+PLUS HMOs. Except as provided in Section 5.03(a)(8), a Member cannot change from a STAR or STAR+PLUS HMO to a different STAR or STAR+PLUS HMO during an Inpatient Stay in a Hospital. (4) Movement from a Medicaid Fee-for-Service or PCCM Program to a STAR or STAR+PLUS HMO. (1) the Medicaid Fee-for-Service program will continue to pay allowable Hospital facility charges until the earlier of the date of Discharge or loss of Medicaid eligibility; and (2) beginning on the Effective Date of Coverage, the STAR or STAR+PLUS HMO will pay for all other Covered Services. (5) Movement from a STAR HMO to the STAR Health MCO. A Medicaid recipient can move from the STAR Program into the STAR Health Program during an Inpatient Stay. In such cases, responsibility for claims incurred during the Inpatient stay will be divided as follows: (1) the STAR HMO will continue to pay Hospital facility charges for Covered Services until th...
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Span of Coverage. (Effective Beginning September 1, 2014) (a) Medicaid MCOs. (1) Open Enrollment. HHSC will conduct continuous open enrollment for Medicaid Eligibles and the MCO must accept all persons who choose to enroll as Members in the MCO or who are assigned as Members in the MCO by HHSC, without regard to the Member’s health status or any other factor. (2) Enrollment Changes during an Inpatient Stay in a Hospital. The following table describes payment responsibility for Medicaid enrollment changes that occur during an Inpatient Stay in a Hospital, as of the Member’s Effective Date of Coverage with the receiving MCO (New MCO). Scenario HospitalFacility Charge All OtherCovered Services 1 Member Retroactively Enrolled in STAR or STAR+PLUS New MCO New MCO 2 Member Prospectively Moves from FFS to STAR or STAR+PLUS FFS New MCO 3 Member Moves between STAR MCOs Former MCO New MCO 4 Member Moves between STAR+PLUS MCOs Former STAR+PLUS MCO New STAR+PLUS MCO 5 Member Moves from STAR to STAR Health Former STAR MCO New STAR Health MCO 7 Member Moves from STAR to STAR+PLUS Former STAR MCO New STAR+PLUS MCO 8 Adult Member Moves from STAR Health to STAR Former STAR Health MCO New STAR MCO The responsible party will pay the Hospital facility charge until the earlier of: (1) date of Discharge from the Hospital, or (2) loss of Medicaid eligibility. For Members who move from STAR or STAR+PLUS into STAR Health, the date of Discharge from the Hospital for behavioral health stays includes extended stay days, as described in the Texas Medicaid Provider Procedures Manual. (3) Enrollment Changes Due to SSI Status. When an adult STAR Member becomes qualified for SSI, the Member will move to STAR+PLUS. When a child STAR Member becomes qualified for SSI, the Member will move to FFS or STAR+PLUS. Section 5.06(c) describes how HHSC will determine the effective date of the Member’s SSI status. (4) Disenrollment from Managed Care during an Inpatient Stay in a Hospital. Children who are voluntarily enrolled in STAR+PLUS can move to FFS during an Inpatient Stay in a Hospital. STAR and STAR+PLUS Members also can move to FFS during an Inpatient Stay in a Hospital under the limited circumstances described in Section 5.02. (e), regarding disenrollment at the MCO’s request. The following table describes how MCOs should divide payment responsibility between entities, beginning on the effective date of FFS coverage.
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Span of Coverage. 23 Section 5.06 Verification of Member Eligibility...............................................................................................23
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Span of Coverage. Medicaid HMOs.
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Span of Coverage. If a Member's effective date of coverage occurs while the Member is confined in a hospital, the CONTRACTOR is responsible for the Member's costs of Covered Services beginning on the Effective Date of Coverage. For each day that the Member is hospitalized beginning on the Effective Date of Coverage, HHSC will pay to CONTRACTOR $700 for non-ICU care and $1400 for ICU care. If a Member is disenrolled while the Member is confined in a hospital, CONTRACTOR's responsibility for the Member's costs of Covered Services terminates on the Date of Disenrollment. Six months after the Implementation Date, the Parties will review CONTRACTOR's data, including, but not limited to, data relating to the timing of discharge and re-admission of Members who are hospitalized at the time of enrollment into CONTRACTOR for the same diagnosis, and if either party believes that these payments are insufficient, either Party can instigate the Change Order process set out in Article 8. The Parties agree to negotiate any requested Change Order in good faith.
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Span of Coverage. (a) Medicaid HMOs. (1) HHSC will conduct continuous open enrollment for Medicaid Eligibles and the HMO must accept all persons who choose to enroll as Members in the HMO or who are assigned as Members in the HMO by HHSC, without regard to the Member’s health status, inpatient status, or any other factor. (2) Members who are disenrolled because they are temporarily ineligible for Medicaid will be automatically re-enrolled into the same health plan, if available. Temporary loss of eligibility is defined as a period of six months or less. (3) A Member cannot change from one Medicaid HMO to another Medicaid HMO during an inpatient hospital stay. Medicaid HMOs are responsible for professional charges during every month for which the HMO receives a full capitation for a Member. (4) The payor responsible for the hospital charges at the start of an Inpatient Stay remains responsible for hospital charges until the time of discharge, or until such time that there is a loss of Medicaid eligibility. Medicaid HMOs are not responsible for any services after the effective date of loss of Medicaid eligibility.
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Span of Coverage 
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Related to Span of Coverage

  • Duration of Coverage Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work hereunder by Xxxxxxxxxx, his/her agents, representatives, employees, or subconsultants.

  • Scope of Coverage 1. This Section shall apply to an investment dispute between a Member State and an investor of another Member State that has incurred loss or damage by reason of an alleged breach of any rights conferred by this Agreement with respect to the investment of that investor. 2. A natural person possessing the nationality or citizenship of a Member State shall not pursue a claim against that Member State under this Section. 3. This Section shall not apply to claims arising out of events which occurred, or claims which have been raised prior to the entry into force of this Agreement. 4. Nothing in this Section shall be construed so as to prevent a disputing investor from seeking administrative or judicial settlement available within the country of a disputing Member State.

  • Terms of Coverage The plan takes effect upon check-in on the booked arrival date to an iTrip unit. All coverage shall terminate upon normal check-out time of the iTrip unit or the departure of the Covered Guest, whichever occurs first.

  • Commencement of Coverage Coverage under the provisions of this article shall apply to regular full-time and regular part-time employees who work 15 regular hours or more per week and shall commence on the first day of the calendar month immediately following the completion of the employee's probationary period.

  • Termination of Coverage This Contract may be terminated as follows:

  • Continuation of Coverage If your coverage is terminated, you may be eligible to continue your coverage in accordance with state or federal law. In accordance with R.I. General Laws §. 27-19.1, if your employment is terminated due to one of the following reason, your healthcare coverage may be continued, provided that you continue to pay the applicable premiums. • Involuntary layoff or death; • The workplace ceasing to exist; or • Permanent reduction in size of the workforce. The period of this continuation will be for up to eighteen (18) months from your termination date, but not to exceed the period of continuous employment preceding termination with your employer. The continuation period will end for any person covered under your policy on the date the person becomes employed by another group and is eligible for benefits under that group’s plan.

  • Verification of Coverage Prior to beginning any work under this Agreement, Consultant shall furnish City with certificates of insurance and with original endorsements effecting coverage required herein. The certificates and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The City reserves the right to require complete, certified copies of all required insurance policies at any time.

  • Evidence of Coverage The Contractor shall, upon request by DSHS, submit a copy of the Certificate of Insurance, policy, and additional insured endorsement for each coverage required of the Contractor under this Contract. The Certificate of Insurance shall identify the Washington State Department of Social and Health Services as the Certificate Holder. A duly authorized representative of each insurer, showing compliance with the insurance requirements specified in this Contract, shall execute each Certificate of Insurance. The Contractor shall maintain copies of Certificates of Insurance, policies, and additional insured endorsements for each subcontractor as evidence that each subcontractor maintains insurance as required by the Contract.

  • Types of Coverage We offer the following types of coverage:

  • Minimum scope of coverage Commercial general coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/88) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. Automobile coverage shall be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed. 12/90) Code 1 (“any auto”). No endorsement shall be attached limiting the coverage.

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