You and Blue Cross & Blue Shield of Rhode Sample Clauses

You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final FDA approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.27 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement.
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You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island, agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0) If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. This agreement provides coverage for health care services that we have reviewed and determined are eligible for coverage. Health care services which we have not reviewed or which we have reviewed and determined are not eligible for coverage are not covered under this agreement. If a service or category of service is not listed as covered, it is not covered under this agreement. Section 3.0 lists the health care services covered under this agreement along with their related exclusions. Section
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You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island, agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0) If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines.
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You and Blue Cross & Blue Shield of Rhode. Island We, Blue Cross & Blue Shield of Rhode Island (BCBSRI), agree to provide coverage for medically necessary covered health care services listed in this agreement. (The term medically necessary is defined in Section 8.0). If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. When possible, we review new services within six (6) months of the occurrence of one of the events described below to determine whether the new service will be eligible for coverage under this agreement: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final FDA approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). For information about prescription drug formulary changes, please see Section 3.28 – Prescription Drugs and Diabetic Equipment/Supplies. During the review period described above, new services are not covered under this agreement. A health care service remains non-covered (excluded) if any of the following occur: • a service is not assigned a CPT or other code; • a service is not approved by the FDA or other governing body; • we do not review a service within six (6) months of the occurrence of one of the events described above; or • we make a determination, after review, not to cover the service under this agreement. Entitlements for payment shall not be more than our allowance, as defined in Section 8.0. All our payments are subject to the terms and conditions outlined in this agreement. This agreement does not limit your coverage based on genetic information. We will not: • adjust premiums based on genetic information; • request or require an individual or family members of an individual to have a genetic test; or • collect genetic information from an individual or family members of an individual before or in connection with enrollment under this agre...
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Related to You and Blue Cross & Blue Shield of Rhode

  • Description of Vendor Entity and Vendor's Goods & Services If awarded, this description of Vendor and Vendor's goods and services will appear on the TIPS website for customer/public viewing. Construction procurement agency, administrating and facilitating cooperative purchasing. Please identify the individual who will be primarily responsible for all TIPS matters and inquiries for the duration of the contract. Xxxxxx Xxxxxxxx Primary Contact Title Partner Please enter a valid email address that will definitely reach the Primary Contact. xxx@xxxxxxxxxxxxxxxxxxx.xxx Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). Please provide the accurate and current phone number where the individual who will be primarily responsible for all TIPS matters and inquiries for the duration of the contract can be reached directly. 0000000000 Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 0000000000 Please identify the individual who will be secondarily responsible for all TIPS matters and inquiries for the duration of the contract.

  • TRAINING AND EMPLOYEE DEVELOPMENT 9.1 The Employer and the Union recognize the value and benefit of education and training designed to enhance an employee’s ability to perform their job duties. Training and employee development opportunities will be provided to employees in accordance with Employer policies and available resources. 9.2 Attendance at employer-required training will be considered time worked. The Employer will make reasonable attempts to schedule employer-required training during an employee’s regular work shift. The Employer will pay the registration and associated travel costs in accordance with Article 23, Travel, for employer-required training.

  • Programs to Keep You Healthy Many health problems can be prevented by making positive changes to your lifestyle, including exercising regularly, eating a healthy diet, and not smoking. As a member, you can take advantage of our wellness programs at no additional cost. We offer wellness programs to our members from time to time. These programs include, but are not limited to: • online and in-person educational programs; • health assessments; • coaching; • biometric screenings, such as cholesterol or body mass index; • discounts We may provide incentives for you to participate in these programs. These incentives may include credits toward premium, and a reduction or waiver of deductible and/or copayments for certain covered healthcare services, as permitted by applicable state and federal law. For the subscriber of the plan, wellness incentives may also include rewards, which may take the form of cash or cash equivalents such as gift cards, discounts, and others. These rewards may be taxable income. Additional information is available on our website. Your participation in a wellness program may make your employer eligible for a group wellness incentive award. Your participation in our wellness programs is voluntary. We reserve the right to end wellness programs at any time. From time to time, we may offer you coupons, discounts, or other incentives as part of our member incentives program. These coupons, discounts and incentives are not benefits and do not change or affect your benefits under this plan. You must be a member to be eligible for member incentives. Restrictions may apply to these incentives, and we reserve the right to change or stop providing member incentives at any time. Care coordination gives you access to dedicated BCBSRI healthcare professionals, including nurses, dietitians, behavioral health providers, and community resources specialists. These care coordinators can help you set and meet your health goals. You can receive support for many health issues, including, but not limited to: • making the most of your physician’s visits; • navigating through the healthcare system; • managing medications or addressing side effects; • better understanding new or pre-existing medical conditions; • completing preventive screenings; • losing weight. Care Coordination is a personalized service that is part of your existing healthcare coverage and is available at no additional cost to you. For more information, please call (000) 000-XXXX (2273) or visit our website. If you have a chronic condition such as asthma, coronary heart disease, diabetes, congestive heart failure, and/or chronic obstructive pulmonary disease, we’re here to help. Our tools and information can help you manage your condition and improve your health. You may also be eligible to receive help through our care coordination program. This voluntary program is available at no additional cost you. To learn more about disease management, please call (000) 000-0000 or 0-000-000-0000. Our entire contract with you consists of this agreement and our contract with your employer. Your ID card will identify you as a member when you receive the healthcare services covered under this agreement. By presenting your ID card to receive covered healthcare services, you are agreeing to abide by the rules and obligations of this agreement. Your eligibility for benefits is determined under the provisions of this agreement. Your right to appeal and take action is described in Appeals in Section 5. This agreement describes the benefits, exclusions, conditions and limitations provided under your plan. It shall be construed under and shall be governed by the applicable laws and regulations of the State of Rhode Island and federal law as amended from time to time. It replaces any agreement previously issued to you. If this agreement changes, an amendment or new agreement will be provided.

  • Supplier Diversity Seller shall comply with Xxxxx’s Supplier Diversity Program in accordance with Appendix V.

  • Pueblo scholarship This articulation transfer agreement replaces all previous agreements between ACC and CSU-Pueblo in Bachelor of Science in Political Science (Secondary Education). This agreement will be reviewed annually and revised (if necessary) as mutually agreed.

  • EMPLOYEE DEVELOPMENT AND TRAINING 1. The State agrees to provide advice and counseling to employees with respect to career advancement opportunities and agency developments which have an impact on their careers. 2. Regular review of its job-related and career development and training programs will be made by the State in order to provide suitable programs for employees covered by this Agreement. When undertaking any such review, the State shall notify employees of such review and take into account suggestions and proposals made by employees. 3. Employees shall be given a reasonable notice of applicable, development and training programs available. Such notice shall include an explanation of the procedure for applying for the program. Notices of development and training programs shall be posted for reasonable periods in advance on bulletin boards at applicable work locations within the agencies involved. An appointing authority shall make every effort to permit employees' participation in such career development and training programs. Participation in any training inside or outside of work hours which is required by the State as a condition of fulfilling the requirements of the employee's job, or any in-service State training which is conducted or undertaken during normally scheduled work hours will be considered as time worked. 4. The State shall pay tuition, course-related fees, other approved course required costs and for necessary travel and lodging pursuant to established policies and procedures.

  • DISCIPLINE OF EMPLOYEES Section 1. Any action or behavior which reflects discredit upon the City or is a direct hindrance to the effective performance of the City's municipal governmental and proprietary functions may be considered good cause for disciplinary action against an employee and such actions or behavior which may be considered good cause for disciplinary action shall include, but not be limited to the following: A. Habitual use of intoxicating beverages to excess or the use of narcotics. B. Being adjudged guilty of a felony or a misdemeanor involving moral turpitude or disgraceful conduct. C. Taking intoxicating beverages, or being intoxicated, while on duty. D. Engaging in improper political activity as defined in Article IXA, Section 8, of the Charter of the City of Lincoln, Nebraska. E. Offensive conduct or language toward the public or toward City officers or employees. F. Lacking either mental or physical competence to perform assigned duties. G. Damaging or being negligent in the care and handling of City property. H. Violating any lawful and reasonable regulations or directives made or given by a superior. I. Inducing or attempting to induce any officer or employee in the City service to commit an illegal act or to act in violation of any lawful and reasonable departmental or official regulation or order, or participating therein. J. Using or attempting to use personal or political influence or bribery to secure an advantage in an examination or promotion, leave of absence, transfer, change of grade, pay or character of work. K. Failing to pay just debts due or owing or failing to make reasonable provisions for future payment of such debts, thereby causing annoyance to officials of the City, or embarrassment to the City. L. Any unauthorized absence of an employee from duty shall be deemed to be an absence without pay and may be made grounds for disciplinary action by the Department Head. In the absence of such disciplinary action, any employee who absents himself for three or more continuous days without authorized leave shall be deemed to have resigned. Such absence may be covered, however, by the Department Head by a subsequent grant of leave with or without pay where extenuating circumstances are found to have existed. M. Repeated violations of State laws or City ordinances relating to the operation of a motor vehicle or a bus. N. The employee has failed to maintain a satisfactory attendance record whereby a pattern of excessive sick leave and unexcused leaves of absence has been established. O. Intentionally falsifying and/or theft of official records and/or statement/property. Section 2. The Director of Public Works/Utilities may suspend or discharge any employee for cause or suspend any employee for investigation of any accident, incident, or other occurrence after having orally informed such employee, and then confirmed in writing, the reason(s) for such suspension or discharge, the duration of the suspension, and/or the effective date of the discharge. Except as otherwise provided in Section 3 below, any employee who has been so suspended or discharged shall have the right to have his case taken up in accordance with the procedures hereinafter provided in Article 8. If it is found during Steps 1 or 2 of the grievance procedure that there was not cause for the suspension or discharge, such employee shall be reinstated and paid for all time lost through such suspension or discharge at his regular straight time hourly rate of pay, or paid such other amount as may appear to be just. Any suspension or discharge arising from the provisions of Article 31 need not be done in writing. Section 3. If an employee is charged with an offense involving the mishandling of fares or the misappropriation of City funds or property, intentional falsification or theft of official records or statements, immorality or drunkenness, neither such charge nor the discipline meted out in connection therewith shall be subject to the grievance and arbitration procedures provided for in this Agreement unless the grievance or demand for arbitration in such cases be accompanied by a document signed by the employee involved authorizing the City to disclose any and all facts and information pertaining to the case and releasing the City from any and all liability therefor. Section 4. When an employee is notified to come to the office to explain the reason or reasons for any complaint, incident or accident, the employee shall make himself available with representation, if so desired, within forty-eight (48) hours (Saturday, Sunday, holidays, days off excluded). The record of complaint and employee explanation will be made a part of the personnel record only after such meeting. Section 5. In considering disciplinary action, Management will take into account the twelve calendar months prior to the month in which the incident occurred in the employee's record. Section 6. Written reprimands and rebuttals or explanations thereof shall be removed from an employee's personnel file, including such files within a Department, one (1) year after the filing. All reprimands and rebuttals or explanations will be forwarded to the Personnel Department for inclusion into the employee's permanent record. Section 7. No discussion or investigation of anything involving possible disciplinary action shall be over the system radio. Telephone investigations will be for information purposes only and at the option of the employee; however, if the employee is called, the employee will be paid for the actual time spent on the telephone. Section 8. The Union shall receive a written notice of all pre-disciplinary hearings or meetings to be held. This notice shall be provided to the Union at least twenty-four

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Orthodontics We Cover orthodontics used to help restore oral structures to health and function and to treat serious medical conditions such as: cleft palate and cleft lip; maxillary/mandibular micrognathia (underdeveloped upper or lower jaw); extreme mandibular prognathism; severe asymmetry (craniofacial anomalies); ankylosis of the temporomandibular joint; and other significant skeletal dysplasias.

  • Health Plan An appropriately licensed entity that has entered into a contract with Subcontractor, either directly or indirectly, under which Subcontractor provides certain administrative services for Health Plan pursuant to the State Contract. For purposes of this Appendix, Health Plan refers to UnitedHealthcare Insurance Company.

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