Benefit definition
Examples of Benefit in a sentence
Where employee Is absent due to a compensable or Illness, the of benefit premiums that were In effect on the date of the accordance with Article (Employee Benefit Plans) shall not be adversely affected for the duration of absence nor for the first eight (8) pay return to work.
The Contractor’s failure to provide resolution of the Appeal within the required timeframe is an Adverse Benefit Determination and the Aggrieved Person is allowed to file a request for a State Fair Hearing as the Aggrieved Person has already exhausted the Contractor’s internal Appeals process.
The Aggrieved Person may request a standard Appeal, either orally or in writing, within 60 calendar days from the date on the Contractor’s written Notice of Adverse Benefit Determination.
The Contractor is required to send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the date that the timeframe expires.
The Contractor shall pay for Covered Services related to an Adverse Benefit Determination deemed eligible for payment pursuant to the terms of a court or administrative order.