Dual eligible individuals definition

Dual eligible individuals means individuals eligible for both Medicaid and Medicare.
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Dual eligible individuals means individuals eligible for both Medicaid and Medicare. "Eligible" means an individual who has been deemed eligible for Medicaid in the State ofOklahoma and is eligible for participation in the managed care program but who is not yet enrolled in an MCO or DBM.
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Dual eligible individuals means individuals eligible for both Medicaid and Medicare. "Eligible" means an individual who has been deemed Eligible for the SoonerSelect program butwho is not yet enrolled in a CE or DBM.
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Examples of Dual eligible individuals in a sentence

  • Dual eligible individuals shall be enrolled consistent with CMS requirements.

  • Dual eligible individuals must contend with two delivery systems both of which present inadequate networks, prior authorization and other utilization management requirements, and the failure to adhere to standardized medical necessity criteria.

  • Dual eligible individuals will draw on different parts of the integrated service package in order to meet their individual needs.

  • Dual eligible individuals may be enrolled in a CMS-approved demonstration to integrate care for Medicare and Medicaid enrollees (MME), and may be subject to the terms of that demonstration.

  • Dual eligible individuals will only be able to enroll in plans that are at or below the benchmark cost within their region.

  • Dual eligible individuals qualify for both Medicare and Medicaid.

  • These provisions and their implications for D-SNPs and Medicare-Medicaid integration strategies follow.Background: Dual eligible individuals are a complex, high-cost populationThere are currently more than 11 million individuals covered by both Medicare and Medicaid.2 They have significant health and social service needs, multiple chronic conditions, and high costs.

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  • Dual eligible individuals receive services driven by conflicting federal rules and separate funding streams resulting in fragmented and uncoordinated care, and they continue to receive services through a patchwork of health and social programs that are not necessarily person-centered or responsive to individual needs.

  • Dual eligible individuals pay no premium if they enroll in a plan with a premium that is at or below the area average, and pay nominal copayments of up to $5/month for covered drugs.

Related to Dual eligible individuals

  • Eligible Individuals means directors, officers, employees and consultants of the Company or any of its Subsidiaries or Affiliates, and prospective employees and consultants who have accepted offers of employment or consultancy from the Company or its Subsidiaries or Affiliates.

  • Eligible Individual means any person who is an Employee, a Consultant or a Non-Employee Director, as determined by the Administrator.

  • Eligible Person means individuals, corporations, trusts, the estates of deceased individuals, partnerships and unincorporated associations of persons;

  • Eligible Persons or “Households” means one or more natural persons or a family who pays 30 percent of their household income toward their monthly rent and is determined by Grantee to be eligible for rental assistance under this Agreement.

  • Key Individuals means the Service Provider Representatives identified as being key individuals for the provision of the Services as set out in Schedule 5.5.

  • Eligible Employees means each employee of the Company or an Affiliate.

  • Non-Employee Directors means that term as defined in Rule 16b-3 under the 1934 Act.

  • Eligible Participants means persons who, at a particular time, are employees, officers, consultants, or directors of the Company or its subsidiaries;

  • Eligible Directors means, with respect to a Regulated Fund and a Potential Co-Investment Transaction, the members of the Regulated Fund’s Board eligible to vote on that Potential Co-Investment Transaction under Section 57(o) of the Act (treating any registered investment company or series thereof as a BDC for this purpose).

  • qualifying individuals means individuals who have been, or without the assistance might otherwise be—

  • Eligible Recipients means all Employees, all Non-Employee Directors and all Consultants.

  • Designated Employees means a person occupying any of the following position in the Company:

  • Non-Employee Director means a Director who either (i) is not a current employee or officer of the Company or an Affiliate, does not receive compensation, either directly or indirectly, from the Company or an Affiliate for services rendered as a consultant or in any capacity other than as a Director (except for an amount as to which disclosure would not be required under Item 404(a) of Regulation S-K promulgated pursuant to the Securities Act (“Regulation S-K”)), does not possess an interest in any other transaction for which disclosure would be required under Item 404(a) of Regulation S-K, and is not engaged in a business relationship for which disclosure would be required pursuant to Item 404(b) of Regulation S-K; or (ii) is otherwise considered a “non-employee director” for purposes of Rule 16b-3.

  • Eligible Participant means an employee, officer, consultant or director of the Company or any Affiliate.

  • Nonemployee Director Award means any Award granted to a Nonemployee Director.

  • Eligible pupil means a pupil who has been expelled from school under the mandatory expulsion provisions in section 1311 or 1311a of the revised school code, MCL 380.1311 and 380.1311a, a pupil who has been suspended or expelled from school under a local policy, a pupil who is referred by a court, a pupil who is pregnant or is a parent, a pupil who was previously a dropout, or a pupil who is determined by the district to be at risk of dropping out.

  • Prospective employee means any individual who has committed to become an employee of the Company within sixty (60) days from the date an Award is granted to such individual.

  • U.S. Participant means a Participant who is a citizen of the United States or a resident of the United States, as defined in section 7701(a)(30)(A) and section 7701(b)(1) of the Code and any other Participant who is subject to tax under the Code with respect to compensatory awards granted pursuant to the Plan;

  • Non-U.S. Participant means any Participant that if it were a Lender would qualify as a Non-U.S. Lender.

  • Covered Employees means all employees and agents of the Company who are responsible for performing, supervising, overseeing, or managing activities related to the maintenance of online political files, as required by the Political Record- Keeping Statute and Rule.

  • Ineligible Person shall include an individual or entity who: i. is currently excluded, debarred, suspended, or otherwise ineligible to participate in the Federal health care programs or in Federal procurement or nonprocurement programs; or ii. has been convicted of a criminal offense that falls within the scope of 42 U.S.C. § 1320a-7(a), but has not yet been excluded, debarred, suspended, or otherwise declared ineligible.

  • Key Individual means any individual ultimately responsible for establishing or directing policies and procedures of the licensee, such as an executive officer, manager, director, or trustee.

  • Key Employees means Xxxxx Xxxxxxx and Xxxxxxx Xxxxxxx.

  • Small employer carrier means any carrier that offers health benefit plans covering eligible employees of one or more small employers in this state.

  • Active Employees means all employees employed on the Closing Date by Seller for its business who are employed exclusively in Seller’s business as currently conducted, including employees on temporary leave of absence, including family medical leave, military leave, temporary disability or sick leave, but excluding employees on long-term disability leave.

  • Service Awards means such funds as may be awarded by the Court to Plaintiffs to compensate them for their participation in the Action, as described in Section IV of this Agreement.