Dual Eligible Beneficiary definition

Dual Eligible Beneficiary means an individual 21 years of age or older who is enrolled for benefits under Medicare Part A (42 U.S.C. Sec. 1395c et seq.) and Medicare Part B (42 U.S.C. Sec. 1395j et seq.) and is eligible for medical assistance under the Medi-Cal State Plan.
Dual Eligible Beneficiary means an individual 21 years of
Dual Eligible Beneficiary or “Dual Eligible Beneficiaries” or “Dual Eligibles” are those categories of individuals indicated in Attachment A that are eligible for Medicare benefits as well as for Medicaid under the New York’s Medicaid Plan. Medicaid includes coverage of medical services, assistance in paying Medicare Part A and/or Part B premiums, and Cost-Sharing Obligations for Medicare-covered services.

Examples of Dual Eligible Beneficiary in a sentence

  • On behalf of Members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and such Medicare eligibility results in full benefit Dual Eligible Beneficiary status for such Members, Health Plan shall perform the default enrollment process as provided by 42 CFR §§ 422.66 & 422.68.


More Definitions of Dual Eligible Beneficiary

Dual Eligible Beneficiary means a person who is enrolled in Medicaid and Medicare. The term includes elders and adults with disabilities who are enrolled in Medicare and receive Medicaid health coverage and/or financial assistance through the State’s Medicare Premium Payment Program (MPPP).
Dual Eligible Beneficiary means an individual 21 years of age or older who is enrolled for benefits under Medicare Part A (42 U.S.C. § 1395c et seq.) and Medicare Part B (42 U.S.C. § 1395j et seq.) and is eligible for medical assistance under the Medi-Cal State Plan.
Dual Eligible Beneficiary means an individual 21 years of age or older who is enrolled for benefits under Medicare Part A (42 U.S.C. Sec. 1395c et seq.) or Medicare Part B (42 U.S.C. Sec. 1395j et seq.), or both, and is eligible for medical
Dual Eligible Beneficiary means a Medicare managed care recipient who is also eligible for Medicaid, and for whom the State has a responsibility for payment of Cost Sharing Obligations under the Washington State Plan. For purposes of this Agreement, Dual Eligible Enrollees are limited to the following categories of recipients:
Dual Eligible Beneficiary. An Enrollee or Potential Enrollee eligible for both Medicaid and Medicare. Durable Medical Equipment: Equipment, including assistive technology, which: (i) can withstand repeated use; (ii) is used to service a health-related or functional purpose; (iii) is ordered by a Health Care Provider to address an illness, injury, or disability; and (iv) is appropriate for use in the home, work place, or school. Early and Periodic Screening, Diagnostic, and Treatment (“EPSDT”) Program: A Medicaid- mandated program that covers screening and diagnostic services to determine physical and mental deficiencies in Enrollees less than twenty-one (21) years of age, and health care, prevention, treatment, and other measures to correct or ameliorate any deficiencies and Chronic Conditions discovered. Effective Date of Contract: The day the Contract is executed by both Parties. Effective Date of Disenrollment: The date, as defined in Section 5.3.3 of this Contract, on which an Enrollee ceases to be covered under the Contractor’s Plan. Effective Date of Eligibility: The eligibility period specified for each population covered under the GHP as described in Section 5.1.3 of the Contract. Effective Date of Enrollment: shall have the meaning prescribed to it in Section 5.2.2 of the Contract.
Dual Eligible Beneficiary means a Medicare managed care recipient who is also eligible for Medicaid, and for whom HCA has a responsibility for payment of Cost Sharing Obligations under the Washington State Plan. For purposes of this SMAC, Dual Eligibles are limited to the categories of recipients identified in Exhibit 1. Qualified Medicare Beneficiary (QMB Only) and Qualified Medicare Beneficiary with Comprehensive Medical Benefits (QMB+). The QMB benefits covered by this SMAC are limited to the Cost Sharing Obligations as defined by the Washington State Plan.
Dual Eligible Beneficiary. An Enrollee or Potential Enrollee eligible for both Medicaid and Medicare. Early and Periodic Screening, Diagnostic, and Treatment (“EPSDT”) Program: A Medicaid- mandated program that covers screening and diagnostic services to determine physical and mental deficiencies in Enrollees less than twenty-one (21) years of age, and health care, prevention, treatment, and other measures to correct or ameliorate any deficiencies and Chronic Conditions discovered. Effective Date of Enrollment: shall have the meaning prescribed to it in Section 5.2.2 of the Contract. Electronic Health Record (“EHR") System: An electronic record of health-related information on an individual that is created, gathered, managed, and consulted upon by authorized health care clinicians and staff and certified by The Office of the National Coordinator’s Authorized Testing and Certification Bodies (“ONC-ATCBs”).