Full Benefit Dual Eligible Member definition

Full Benefit Dual Eligible Member. A member who is enrolled with an AHCCCS Contractor for full Medicaid services (AHCCCS benefits) and who is also receiving both Medicare Part A and Part B services. These individuals are considered to be Full Benefit Dual Eligible Members, and include Qualified Medicare Beneficiary Plus (QMB Plus), Specified Low-Income Medicare Beneficiary Plus (SLMB Plus) and Other Full Benefit Dual Eligible (Other FBDE) populations. A Full Benefit Dual Eligible Member does not include those individuals enrolled with AHCCCS in the following population categories only through a Medicare Savings Program population (and receive from AHCCCS only Medicare cost sharing assistance): Qualified Medicare Beneficiary Only (QMB Only), Specified Low-Income Medicare Beneficiary Only (SLMB Only) or Qualified Individual-1 (QI-1).
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Examples of Full Benefit Dual Eligible Member in a sentence

  • For an Other Full Benefit Dual Eligible Member, AHCCCS does not provide payment for either Medicare Part A or Part B premiums.

  • For an Other Full Benefit Dual Eligible Member, AHCCCS payments of Medicare coinsurance amounts and Medicare deductibles for Medicare covered services are limited.

  • A Full Benefit Dual Eligible Member does not include those persons enrolled in a Medicare Savings Program population: Qualified Medicare Beneficiary only (QMB only), Specified Low- Income Medicare Beneficiary only (SLMB only) or Qualified Individual-1 (QI-1).

  • XXX is responsible for the coordination of both Medicare and Medicaid integrated health care benefits, regardless of whether a Full Benefit Dual Eligible Member is enrolled with XXX’s companion ACC, ALTCS E-PD Health Plan, ALTCS DD Health Plan, or ACC-RBHA health plan for Medicaid benefits.

  • MAO shall only enroll an eligible Full Benefit Dual Eligible Member in accordance with the terms, service area counties and plan benefit packages listed for each of the respective AHCCCS companion Medicaid MCO contracts, programs and populations as specified in Section 4 of this Agreement.

  • For a Full Benefit Dual Eligible Member not enrolled in XXX’s integrated companion ACC, ALTCS E-PD, ALTCS DD, or ACC-RBHA health plan, MAO shall verify such member’s AHCCCS program eligibility through the AHCCCS Online real-time web portal at: xxxxx://xxxxx.xxxxxxxxxxxxx.xx/Account/Login.aspx?ReturnUrl=%2f.

  • A QMB Plus Full Benefit Dual Eligible Member has no legal obligation to make further payment to a provider or to MAO for Medicare Part A or Part B cost sharing amounts.

  • Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from balance billing a QMB Plus Full Benefit Dual Eligible Member for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments.

  • Such coordination shall include proposed prospective SSCBIs that have a reasonable expectation of improving or maintaining the health or overall function of such an AHCCCS Full Benefit Dual Eligible Member as tailored to the individual’s needs, for those such who are enrolled with MAO.

  • Payment of enrolled Full Benefit Dual Eligible Member Medicare cost sharing effective CY2023 as described per the CY2023 Medicare Advantage Final Rule published in the Federal Register of May 9, 2022, and as may be amended in the future.

Related to Full Benefit Dual Eligible Member

  • Disability benefit recipient means a member who is receiving a disability benefit.

  • Pre-Retirement Survivor Benefit means the benefit set forth in Article 6.

  • Accrued Benefit means the amount standing in a Participant's Account(s) as of any date derived from both Employer contributions and Employee contributions, if any.

  • Eligible employer means any municipality with a municipal

  • Net Benefits Test means a calculation to determine whether the benefits of a reduction in price resulting from the dispatch of Economic Load Response exceeds the cost to other loads resulting from the billing unit effects of the load reduction, as specified in Operating Agreement, Schedule 1, section 3.3A.4 and the parallel provisions of Tariff, Attachment K-Appendix, section 3.3A.4.

  • Plan Benefit means the benefit payable to a Participant as calculated in Article V.

  • Annual Benefit Limit means the maximum amount of benefits paid by the Company to the Policy Holder in a Policy Year irrespective of whether any limits of any benefit items stated in the Benefit Schedule have been reached. The Annual Benefit Limit is counted afresh in a new Policy Year.

  • Social Security Retirement Age means the age used as the retirement age under Section 216(l) of the Social Security Act, applied without regard to the age increase factor and as if the early retirement age under Section 216(l)(2) of such Act were 62.

  • Excess Elective Deferrals means the amount of Elective Deferrals (as defined below) for a calendar year that the Participant designates to the Plan pursuant to the following procedure. The Participant’s designation: shall be submitted to the Administrator in writing no later than March 1; shall specify the Participant’s Excess Elective Deferrals for the preceding calendar year; and shall be accompanied by the Participant’s written statement that if the Excess Elective Deferrals is not distributed, it will, when added to amounts deferred under other plans or arrangements described in Section 401(k), 408(k) or 403(b) of the Code, exceed the limit imposed on the Participant by Section 402(g) of the Code for the year in which the deferral occurred. Excess Elective Deferrals shall mean those Elective Deferrals that are includible in a Participant's gross income under Section 402(g) of the Code to the extent such Participant's Elective Deferrals for a taxable year exceed the dollar limitation under such Code section.

  • Disability Retirement Date means the first day of the month following the last day of paid employment;

  • Retirement Eligibility means attainment of age 60 and completion of at least five (5) years of continuous service with the Company.

  • Employer Contribution means the amount paid by an employer, as determined by the employer rate, including the normal and deficiency rates, contributions, and funds wherever used in this chapter.

  • Eligible Employee means full-time and part-time employees in the bargaining unit who have completed four hundred and fifty (450) hours of service and who are not prohibited from contributing to the Plan by legislation or the Plan rules because of their age or because they are in receipt of a pension from the Plan.

  • Elective Deferral means the portion of Compensation which is deferred by a Participant under Section 4.1.

  • Retirement Eligible means that the Participant has either attained age 55 and completed ten (10) years of Service as an Employee or attained age 60 and completed five (5) years of Service as an Employee.

  • Surviving Spouse means the widow or widower, as the case may be, of a Deceased Participant or a Deceased Beneficiary (as applicable).

  • Elective Deferral Account means the account established hereunder to which Elective Deferrals (including a separate accounting for Catch-Up Contributions) are allocated. Amounts in the Participant's Elective Deferral Account are nonforfeitable when made and are subject to the distribution restrictions of Section 12.2(e). The Elective Deferral Account may consist of the

  • Supplemental Benefit means the monthly benefit payable to the Executive under this Agreement.

  • Disability retirement for plan 1 members, means the period

  • Active Participant means, with respect to any day or date, a Participant who is in Service on such day or date; provided, that a Participant shall cease to be an Active Participant (i) immediately upon a determination by the Committee that the Participant has ceased to be an Employee or Independent Contractor, or (ii) at the end of the Plan Year that the Committee determines the Participant no longer meets the eligibility requirements of the Plan.

  • Lifetime Benefit Limit means the maximum amount of benefits paid by the Company to the Policy Holder cumulatively since the inception of these Terms and Benefits, irrespective whether any limits of any benefit items stated in the Benefit Schedule have been reached or whether the Annual Benefit Limit in a Policy Year has been reached.

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

  • Termination Benefit means the benefit set forth in Article 7.

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

  • Disabled Participant with respect to a loan if it has no right to exercise any voting or other control rights with respect to such loan (other than the right to approve amendments to the material economic terms of such loan).

  • Individual retirement account means a trust, custodial arrangement, or annuity under Section 408(a) or (b), Internal Revenue Code of 1954 (26 U.S.C. Section 408 (1986)).