Step-by-step Sample Clauses

Step-by-step. How to ask for a coverage decision (how to ask our plan to authorize or provide the medical care coverage you want) Legal Terms When a coverage decision involves your medical care, it is called an “organization determination.”
Sample 1Sample 2
AutoNDA by SimpleDocs
Step-by-step. How to make a Level 1 Appeal (how to ask for a review of a medical care coverage decision made by our plan) Legal When you start the appeal process by Terms making an appeal, it is called the “first level of appeal” or a “Level 1 Appeal.” An appeal to the plan about a medical care coverage decision is called a plan “reconsideration.”
Sample 1Sample 2
Step-by-step. How to make a Level 1 Appeal to have our plan cover your care for a longer time If you want to ask us to cover your care for a longer period of time, you will need to use the appeals process to make this request. Before you start, understand what you need to do and what the deadlines are. • Follow the process. Each step in the first two levels of the appeals process is explained below. • Meet the deadlines. The deadlines are important. Be sure that you understand and follow the deadlines that apply to things you must do. There are also deadlines our plan must follow. (If you think we are not meeting our deadlines, you can file a complaint. Section 9 of this chapter tells you how to file a complaint.) • Ask for help if you need it. If you have questions or need help at any time, please call Customer Service (phone numbers are on the front cover of this booklet). Or call your State Health Insurance Assistance Program, a government organization that provides personalized assistance (see Section 2 of this chapter). During a Level 1 Appeal, the Quality Improvement Organization reviews your appeal and decides whether to change the decision made by our plan. Legal When you start the appeal process by making an appeal, Terms it is called the “first level of appeal” or “Level 1 Appeal.” Step 1: Make your Level 1 Appeal: contact the Quality Improvement Organization in your state and ask for a review. You must act quickly. What is the Quality Improvement Organization? • This organization is a group of doctors and other health care experts who are paid by the Federal government. These experts are not part of our plan. They check on the quality of care received by people with Medicare and review plan decisions about when it’s time to stop covering certain kinds of medical care. How can you contact this organization? • The written notice you received tells you how to reach this organization. What should you ask for? • Ask this organization to do an independent review of whether it is medically appropriate for our plan to end coverage for your medical services. Your deadline for contacting this organization. • You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care. • If you miss the deadline for contacting the Quality Improvement Organization about your appeal, you can make your appeal directly to our plan instead. For details about this...
Sample 1Sample 2

Related to Step-by-step

  • Fourth Step If U1 is greater than or equal to U2, a standard known resistance (Ro) is inserted between the negative side of the high voltage bus and the electrical chassis. With Ro installed, the voltage (U1') between the negative side of the high voltage bus and the electrical chassis is measured (see Figure 5). The electrical isolation (Ri) is calculated according to the following formula: Ri = Ro*Ub*(1/U1' – 1/U1) Figure 5 Measurement of U1’ Electrical Chassis Energy Conversion System Assembly REESS High Voltage Bus + + Energy Conversion System - REESS - U1’ R0 Traction System Electrical Chassis If U2 is greater than U1, insert a standard known resistance (Ro) between the positive side of the high voltage bus and the electrical chassis. With Ro installed, measure the voltage (U2’) between the positive side of the high voltage bus and the electrical chassis (see Figure 6 below). The electrical isolation (Ri) is calculated according to the following formula: Ri = Ro*Ub*(1/U2’ – 1/U2) Figure 6 Measurement of U2’ U2’

  • First Step If a dispute cannot be resolved by this method, the Accredited Union Representative may file a formal grievance on the prescribed form with EPSCA/the Employer within fifteen (15) working days of the alleged grievous act. Within ten (10) working days of the filing of the grievance, EPSCA/the Employer shall investigate the grievance and convene a First Step meeting which he or the Accredited Union Representative considers necessary to resolve it. The Management Committee shall be comprised of EPSCA or their designate plus at least one representative of the Employer named in the grievance. The Union Committee shall include at least two persons, one of whom shall be the Accredited Union Representative for the grievor. EPSCA/the Employer shall give his reply on the prescribed form to the Accredited Union Representative within five (5) working days from the date of the First Step meeting. Copies of completed grievance forms signed by the appropriate parties shall be filed by EPSCA/the Employer with the General Manager of EPSCA. The Accredited Union Representative for the grievor will file a copy with the Union. The EPSCA/the Employer will send a copy of any signed first step grievance settlement between the Accredited Union Representative and EPSCA/the Employer to the Union and EPSCA office.

  • STEP The grievance shall be submitted to the Associate Director, Corporate Services. The Associate Director, Corporate Services shall reply in writing within five (5) days after receipt of the Grievance. STEP Failing settlement being reached in Step the Union Grievance Committee, within ten days of the reply of the Associate Director, Corporate Services in Step above, but not thereafter, shall present the Grievance to the Director of Education at a meeting requested for that purpose. The griever shall have the right to be present at the meeting. The Director of Education shall reply in writing within ten days of the meeting. Failing satisfaction with such reply the Union may within twenty (20) days of the receipt of the reply in Step but not thereafter refer the Grievance to Arbitration. Arbitration The party desiring arbitration shall notify the other party in writing of its desire to submit the difference or allegation to arbitration and the notice shall contain the name of the first party‘s appointeeto an Board. The recipientof the notice shall, within five (5) days, inform the other party of the name of its appointeeto the Arbitration Board. The two appointees so selected, shall, within five (5) days of the appointment of the second of them, appoint a third person who shall be the Chair. If the recipient of the notice fails to appoint an Appointee or if the two appointees fail to agree upon a Chair within five (5) days, the appointment shall be made by the Minister of Labour upon the request of either party. The Arbitration Board shall hear pertinent representationby the parties representativesand determine the difference or allegation and shall issue a decision and the decision shall be final and binding upon the parties and upon any employee or the Board affected by it. The decision of a majority is the decision of the Arbitration Board, but, if there is no majority, the decision of the Chair governs. The Arbitration Board, shall not, by its decision, add to, delete from, modify or otherwise amend the provisions of the Agreement. Where a dispute involving a question of general applicationor interpretation of the terms of this Agreement arises, the Union may file a Grievance at Step of the Grievance Procedure provided such grievance must be initiated within twenty (20) days of when the Union became or ought reasonably to have become aware of the occurrence which gave rise to the complaint. The Union shall present grievance in writing, specify the Article or Articles of the Agreement alleged to have been violated and relief sought.

  • NEXT STEPS If you disagree with my findings you may request a hearing to appeal the decision by contacting me using the details provided. If you would like to discuss your application or if there is any confusion on how to proceed, you can write to, e-mail or telephone me. My contact details are shown at the top of this letter. Failure to Respond If you fail to respond by the date given above, your application will be refused under Section 3A(4) of the Registered Designs Act 1949.

  • Third Step In the event a grievance has not been satisfactorily resolved at the second step, the aggrieved teacher shall file, within five (5) school days of the principal’s written decision at the second step, a copy of the grievance with the Superintendent. Within ten (10) school days after such written grievance is filed, the aggrieved and the Superintendent or his/her designee shall meet to resolve the grievance. The Superintendent or his/her designee shall file an answer within ten (10) school days of the third step grievance meeting and communicate it in writing to the teacher and the principal.

  • MODIFICATION BY SUBSEQUENT AGREEMENT This Agreement may be modified by subsequent agreement of the Couple only by an instrument in writing signed by both of them, an oral agreement to the extent that the Couple executes it, or an in-court oral agreement made into an order by a court of competent jurisdiction.

  • Modification to Article V, Section 4 of the DPA Article V, Section 4 of the DPA (Data Breach.) is amended with the following additions: (6) For purposes of defining an unauthorized disclosure or security breach, this definition specifically includes meanings assigned by Texas law, including applicable provisions in the Texas Education Code and Texas Business and Commerce Code.

  • Step One a. The local or an employee alleging a grievance ("the grievor") shall request a meeting with the employer official directly responsible, and at such meeting they shall attempt to resolve the grievance summarily. Where the grievor is not the local, the grievor shall be accompanied at this meeting by a representative appointed by the local.

  • Amendment by Mutual Consent 55.01 It is agreed by the parties to this Agreement that any provision in this Agreement, other than the duration of agreement, may be amended by mutual consent of the Employer and the Union.

  • Amendments by us 2.1 We may vary any details of this agreement or a Direct Debit Request at any time by giving you at least fourteen (14) days written notice.

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