Summaries of Benefits and Coverage Sample Clauses

Summaries of Benefits and Coverage. Under section 2715 of the Public Health Service Act, created by the Patient Protection and Affordable Care Act (the Affordable Care Act) and as implemented by summary of benefits and coverage regulations, certain employer groups and their employees who are eligible to enroll in, or who are enrolled in, the employer group’s health plan(s) are entitled to a Summary of Benefits and Coverage (and the uniform Glossary of Health Coverage and Medical Terms, which is available on the U.S. Departments of Labor and Health and Human Services Web sites as well as the Blue Cross and Blue Shield Web site) in certain circumstances on and after September 23, 2012. Blue Cross and Blue Shield will provide Summaries of Benefits and Coverage to you in accordance with the provisions described in this Agreement. You agree that Blue Cross and Blue Shield will not be responsible for providing Summaries of Benefits and Coverage to your employees. For each of the Blue Cross and Blue Shield standard plan design(s) offered to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide you with either a Web site address where you can obtain a copy of the standard Summary of Benefits and Coverage or, upon your request, a copy of the standard Summary of Benefits and Coverage in electronic (PDF) and/or printed format. Access to Summaries of Benefits and Coverage for standard plan designs will be available at least 60 days prior to your coverage effective date or your subsequent renewal date, or within seven business days of your request to Blue Cross and Blue Shield. In the event you have chosen to offer customized, non-standard Blue Cross and Blue Shield plan design(s) to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide a copy of the Summary of Benefits and Coverage for each customized plan design to you in accordance with the Affordable Care Act and associated regulations. If there are changes that necessitate updating the Summary of Benefits and Coverage after it is provided to you, Blue Cross and Blue Shield will provide the updated Summary of Benefits and Coverage to you within seven business days of the change(s) being identified, but only when the requested changes reflect health care benefits provided by Blue Cross and Blue Shield. Generally, any Summary of Benefits and Coverage provided by Blue Cross and Blue Shield will describe only the health care benefits provided under this Agreement and will not describe health...
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Summaries of Benefits and Coverage. Under section 2715 of the Public Health Service Act, created by the Patient Protection and Affordable Care Act (the Affordable Care Act) and as implemented by summary of benefits and coverage regulations, certain employer groups and their employees who are eligible to enroll in, or who are enrolled in, the employer group’s health plan(s) are entitled to a Summary of Benefits and Coverage (and the uniform Glossary of Health Coverage and Medical Terms, which is available on the U.S. Departments of Labor and Health and Human Services Web sites as well as the Blue Cross and Blue Shield Web site) in certain circumstances on and after September 23, 2012. Blue Cross and Blue Shield will provide Summaries of Benefits and Coverage to you in accordance with the provisions described in this Agreement. You agree that Blue Cross and Blue Shield will not be responsible for providing Summaries of Benefits and Coverage to your employees.
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Related to Summaries of Benefits and Coverage

  • Coordination of Benefits and Subrogation IPA and HMO shall establish and implement a system for coordination of benefits and subrogation, in accordance with those rules established under the HMO's policies and procedures and applicable federal and state laws. If known to IPA, IPA shall identify and inform HMO of Members for whom coordination of benefits and subrogation opportunities exist. HMO hereby authorizes IPA to seek payment, on a fee-for service basis or otherwise, from any insurance carrier, organization, or government agency which is primarily responsible for the payment or provision of medical services provided by IPA under this Agreement which can be recovered by reason of coordination of benefits, motor vehicle injury, worker's compensation, temporary disability, occupational disease, or similar exclusionary or limiting provisions, to the extent authorized by the applicable and not otherwise prohibited by law.

  • Description of Benefits The benefits available under this Plan will be as defined in Items F(1), F(3), and F(4) of the Adoption Agreement.

  • Loss of Benefits Employees who are separated from the service by a discharge under other than honorable conditions, bad conduct, or dishonorable discharge shall not be entitled to any of the benefits of Section 3 through Section 9 of the Article (relating to military leaves without pay) except such vested rights as they may have acquired thereto by virtue of payments made into their retirement accounts.

  • Release Prior to Payment of Benefits Upon the occurrence of a Change in Control Termination or a Covered Termination, as applicable, and prior to Executive earning any entitlement to any severance or separation benefits under this Agreement on account of such Change in Control Termination or Covered Termination, as applicable, Executive must execute the appropriate Release, and such Release must become effective in accordance with its terms, but in no event later than the Release Deadline Date. No amount shall be paid prior to such date. Instead, on the first regularly-scheduled payroll date occurring on or after the Release Deadline Date, the Company will pay Executive the severance amount that Executive would otherwise have received on or prior to such date but for the delay in payment related to the effectiveness of the Release, with the balance of the severance amount being paid as originally scheduled. The Company may modify the Release in its discretion to comply with changes in applicable law at any time prior to Executive’s execution of such Release. Such Release shall specifically relate to all of Executive’s rights and claims in existence at the time of such execution and shall confirm Executive’s obligations under the Confidentiality Agreement and any similar obligations under applicable law. It is understood that, as specified in the applicable Release, Executive has a certain number of calendar days to consider whether to execute such Release. If Executive does not execute and deliver such Release within the applicable period, no benefits shall be provided or payable under this Agreement, and Executive shall have no further rights, title or interests in or to any severance benefits or payments pursuant to this Agreement. It is further understood that if Executive is age 40 or older at the time of a Change in Control Termination or a Covered Termination, as applicable, Executive may revoke the applicable Release within seven (7) calendar days after its execution by Executive. If Executive revokes such Release within such subsequent seven (7) day period, no benefits shall be provided or payable under this Agreement pursuant to such Change in Control Termination or Covered Termination, as applicable.

  • Coordination of Benefits i. Delta Dental coordinates the dental Benefits under this dental plan with your benefits under any other group or pre-paid plan or insurance plan designed to fully integrate with other plans. If this plan is the “primary” plan, Delta Dental will not reduce Benefits. If this plan is the “secondary” plan, Delta Dental may reduce Benefits so that the total benefits paid or provided by all plans do not exceed 100% of total allowable expense. ii. How does Delta Dental determine which Plan is the “primary” plan? 1) The plan covering the Enrollee as an employee is primary over a plan covering the Enrollee as a dependent. 2) The plan covering the Enrollee as an employee is primary over a plan covering the insured person as a dependent; except that if the insured person is also a Medicare beneficiary, and as a result of the rule established by Title XVIII of the Social Security Act and implementing regulations, Medicare is: a) secondary to the plan covering the insured person as a dependent; and b) primary to the plan covering the insured person as other than a dependent (e.g. a retired employee), then the benefits of the plan covering the insured person as a dependent are determined before those of the plan covering that insured person as other than a dependent. 3) Except as stated in paragraph 4), when this plan and another plan cover the same child as a dependent of different persons, called parents: a) the benefits of the plan of the parent whose birthday falls earlier in a year are determined before those of the plan of the parent whose birthday falls later in that year; but b) if both parents have the same birthday, the benefits of the plan covering one parent longer are determined before those of the plan covering the other parent for a shorter period of time. c) However, if the other plan does not have the birthday rule described above, but instead has a rule based on the gender of the parent, and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan determines the order of benefits. 4) In the case of a dependent child of legally separated or divorced parents, the plan covering the Enrollee as a dependent of the parent with legal custody or as a dependent of the custodial parent’s spouse (i.e. step-parent) will be primary over the plan covering the Enrollee as a dependent of the parent without legal custody. If there is a court decree establishing financial responsibility for the health care expenses with respect to the child, the benefits of a plan covering the child as a dependent of the parent with such financial responsibility will be determined before the benefits of any other policy covering the child as a dependent child. 5) If the specific terms of a court decree state that the parents will share joint custody without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child will follow the order of benefit determination rules outlined in paragraph 3). 6) The benefits of a plan covering an insured person as an employee who is neither laid-off nor retired are determined before those of a plan covering that insured person as a laid-off or retired employee. The same would hold true if an insured person is a dependent of a person covered as a retiree or an employee. If the other plan does not have this rule, and if, as a result, the plans do not agree on the order of benefits, this rule 6) is ignored. 7) If an insured person whose coverage is provided under a right of continuation pursuant to federal or state law also is covered under another plan, the following will be the order of benefit determination. a) First, the benefits of a plan covering the insured person as an employee (or as that insured person’s dependent). b) Second, the benefits under the continuation coverage. c) If the other plan does not have the rule described above, and if, as a result, the plans do not agree on the order of benefits, this rule 7) is ignored. 8) If none of the above rules determines the order of benefits, the benefits of the plan covering an employee longer are determined before those of the plan covering that insured person for the shorter term. 9) When determination cannot be made in accordance with the above for Pediatric Benefits, the benefits of a plan that is a medical plan covering dental as a benefit will be primary to a dental only plan.

  • Cessation of Benefits An employee shall cease to be eligible for benefits of this Plan at the earliest of the following dates: (a) at the end of the month in which the employee reaches his/her sixty-fifth (65th) birthday; (b) on the date of commencement of paid absence prior to retirement; (c) on the date of termination of employment with the Employer. Benefits will not be paid when an employee is serving a prison sentence. Cessation of active employment as a regular employee shall be considered termination of employment except when an employee is on authorized leave of absence with or without pay.

  • Benefits and Insurance The Executive shall, in accordance with Company policy and the terms of the applicable plan documents, be eligible to participate in benefits under any benefit plan or arrangement that may be in effect from time to time and made available to similarly situated Company executives (including, but not limited to, being named as an officer for purposes of the Company’s Directors & Officers insurance policy). The Company reserves the right in its sole discretion to modify, add or eliminate benefits at any time. All benefits shall be subject to the terms and conditions of the applicable plan documents, which may be amended or terminated at any time. The Executive shall be entitled to vacation each year, in addition to sick leave and observed holidays in accordance with the policies and practices of the Company. Vacation may be taken at such times and intervals as the Executive shall determine, subject to the business needs of the Company.

  • Payment of Benefits All or part of the contract benefits may be paid under one or more of the following: - a variable payment plan; - a fixed payment plan; or - in cash. The provisions and rate for variable and fixed payment plans are described in Section 11. Contract benefits may not be placed under a payment plan unless the plan would provide to each beneficiary a monthly income the initial amount of which is at least the minimum payment amount shown on page 4. A Withdrawal Charge will be deducted from contract benefits before their payment under certain conditions described in Section 7.3.

  • PORTABILITY OF BENEFITS The following benefits are portable: 6.01 Accumulated income protection benefits/sick leave credits. 6.02 Length of employment applicable to rate at which vacation is earned. 6.03 Length of employment applicable to pre-retirement leave. NOTE: Deer Lodge Centre limits payment of pre-retirement leave to service acquired since April 1, 1983. Incoming employees would retain original service date for this purpose. 6.04 Length of employment for the purpose of qualifying to join benefit plans, e.g., two (2) year pension requirement.

  • Termination of Benefits Except as provided in Section 2 above or as may be required by law, Executive’s participation in all employee benefit (pension and welfare) and compensation plans of the Company shall cease as of the Termination Date. Nothing contained herein shall limit or otherwise impair Executive’s right to receive pension or similar benefit payments that are vested as of the Termination Date under any applicable tax-qualified pension or other plans, pursuant to the terms of the applicable plan.

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