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HEALTH BENEFIT PROGRAM definition

HEALTH BENEFIT PROGRAM means the Group Health Insurance Program that provides group health BENEFITS to eligible State of Wisconsin and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes. This program is established, maintained and administered by the BOARD. HIGH DEDUCTIBLE HEALTH PLAN (HDHP) as defined in UNIFORM BENEFITS. HOSPITAL as defined in UNIFORM BENEFITS. IN-NETWORK refers to a provider who has agreed in writing by executing a participation agreement to provide, prescribe or direct health care services, supplies or other items covered under the policy to PARTICIPANTS. The provider's written participation agreement must be in force at the time such services, supplies or other items covered under the policy are provided to a PARTICIPANT. The CONTRACTOR agrees to give PARTICIPANTS lists of affiliated providers. Some providers require prior authorization by the CONTRACTOR in advance of the services being provided. INPATIENT means a PARTICIPANT admitted as a bed patient to a health care facility or in twenty-four (24)-hour home care. IT’S YOUR CHOICE OPEN ENROLLMENT means the enrollment period referred to in the DEPARTMENT materials as the It’s Your Choice enrollment period that is available at least annually to insured SUBSCRIBERS allowing them the opportunity to change CONTRACTORS and/or coverage and also to eligible individuals to enroll for coverage in any CONTRACTOR offered by the BOARD. OUT-OF-NETWORK refers to a provider who does not have a signed participating provider agreement and is not listed on the most current edition of the CONTRACTOR’S professional directory of providers. Care from an OUT-OF-NETWORK provider may require prior-authorization from the CONTRACTOR unless it is an emergency or urgent care. PARTICIPANT means the SUBSCRIBER or any of the SUBSCRIBER'S DEPENDENTS who have been specified by the DEPARTMENT for enrollment and are entitled to BENEFITS. PHARMACY BENEFIT MANAGER (PBM) as defined in UNIFORM BENEFITS. PREMIUM means the rates shown in the It’s Your Choice materials that includes the medical, pharmacy, and dental (when applicable) components, and administration fees required by the BOARD. Those rates may be revised by the BOARD annually, effective on each succeeding January 1 following the effective date of this AGREEMENT. The PREMIUM includes the amount paid by the EMPLOYER when the EMPLOYER contributes toward the PREMIUM. QUARTERLY means a period consisting of e...
HEALTH BENEFIT PROGRAM means the Group Health Insurance Program that provides group health BENEFITS to eligible State of Wisconsin and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes. The HEALTH BENEFIT PROGRAM is established, maintained and administered by the BOARD. HIGH DEDUCTIBLE HEALTH PLAN (HDHP) as defined in UNIFORM BENEFITS. HOSPITAL as defined in UNIFORM BENEFITS. IN-NETWORK refers to a provider who has agreed in writing by executing a participation agreement to provide, prescribe or direct health care services, supplies or other items covered under the policy to PARTICIPANTS. The provider's written participation agreement must be in force at the time such services, supplies or other items covered under the policy are provided to a PARTICIPANT. The CONTRACTOR agrees to give PARTICIPANTS lists of affiliated providers. Some providers require prior authorization by the CONTRACTOR in advance of the services being provided. INPATIENT means a PARTICIPANT admitted as a bed patient to a health care facility or in twenty-four (24)-hour home care. IT’S YOUR CHOICE OPEN ENROLLMENT means the enrollment period referred to in the DEPARTMENT materials as the It’s Your Choice enrollment period that occurs at least annually to insured SUBSCRIBERS allowing them the opportunity to change CONTRACTORS and/or coverage and also to eligible individuals to enroll for coverage in any CONTRACTOR offered by the BOARD. MEDICARE ADVANTAGE means a program defined under Title 18, Part C of the U.S. Social Security act of 1965, as amended.
HEALTH BENEFIT PROGRAM means a benefit program (i) specifying health care services to be reimbursed, paid for or provided to individuals lawfully participating in that benefits program; (ii) employing financial incentives to utilize Participating Providers; and (iii) issued, administered or serviced by AHM or an Affiliate.

Examples of HEALTH BENEFIT PROGRAM in a sentence

  • All medical claims administrative services for the HEALTH BENEFIT PROGRAM shall be fully operational.

  • The BOARD may allow an organization that has substantially but not completely met the requirements of this AGREEMENT to participate but not be considered qualified in the first year of operation in the HEALTH BENEFIT PROGRAM for purposes of establishing the EMPLOYER contribution toward PREMIUM when the contribution is based on a percentage of the lowest / average cost qualified plan.

  • The CONTRACTOR’S dedicated toll-free customer service telephone number shall be operational and customer service staff for the HEALTH BENEFIT PROGRAM are trained.

  • The organization must submit a proposal to the BOARD to participate in the HEALTH BENEFIT PROGRAM.

  • Although the DEPARTMENT is responsible for eligibility determination and enrollment, the CONTRACTOR shall maintain an enrollment/eligibility system to support the HEALTH BENEFIT PROGRAM.

  • Web content will provide basic HEALTH BENEFIT PROGRAM information.

  • PERS HEALTH BENEFIT PROGRAM The City has elected to participate in the PERS Health Benefit Program.

  • A PARTICIPANT’S right to BENEFITS is subject to the terms, conditions, limitations and exclusions of the HEALTH BENEFIT PROGRAM.

  • At least ninety-five percent (95%) of all claims received must be processed within thirty (30) calendar DAYS of receipt of all necessary information, except for those claims for which the HEALTH BENEFIT PROGRAM is the secondary payer.

  • If the EMPLOYEE, ANNUITANT, CONTINUANT or DEPENDENT has more than one period of Medicare enrollment based on kidney disease, there is a separate thirty (30)-month period during which the HEALTH BENEFIT PROGRAM will again be the primary payer.


More Definitions of HEALTH BENEFIT PROGRAM

HEALTH BENEFIT PROGRAM means the program that provides group health BENEFITS to eligible State of Wisconsin and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes. This program is established, maintained and administered by the BOARD. IDENTIFICATION CARDS or ID CARDS means cards indicating eligibility of PARTICIPANTS, printed in the most current NCPDP (National Council for Prescription Drug Processing) version. These cards will be distributed upon initial enrollment, upon a change in the PHARMACY BENEFIT PLAN, or upon request of the PARTICIPANT. IT’S YOUR CHOICE OPEN ENROLLMENT or IYC means the enrollment period referred to in the DEPARTMENT materials as the IYC enrollment period that is available at least annually to insured SUBSCRIBERS allowing them the opportunity to change health plans and/or coverage and also to eligible individuals to enroll for coverage in any health plan offered by the BOARD. ONLINE TRANSACTION PROCESSING means the process of settling claims, from submission through final disposition, between two or more parties. PARTICIPANT means the SUBSCRIBER or any of the SUBSCRIBER'S DEPENDENTS who have been specified by the DEPARTMENT for enrollment and are entitled to BENEFITS. PARTICIPATING PHARMACY means a pharmacy or a company that is authorized to represent one or more subsidiary, affiliated, or franchised pharmacies, that has entered into a PARTICIPATING PHARMACY agreement with CONTRACTOR to provide COVERED PRODUCTS to PARTICIPANTS. PARTICIPATING PRESCRIBERS means those prescribers who are authorized to prescribe medication to PARTICIPANTS under the PHARMACY BENEFIT PLAN. PBM means Pharmacy Benefit Manager.
HEALTH BENEFIT PROGRAM means the Group Health Insurance Program that provides group health benefits to eligible STATE EMPLOYEES, STATE ANNUITANTS, CONTINUANTS and their eligible dependents in accordance with Chapter 40, Wisconsin Statutes. The HEALTH BENEFIT PROGRAM is established, maintained and administered by the BOARD. HEALTH SAVINGS ACCOUNT or HSA is an account that allows a PARTICIPANT enrolled in an HDHP plan to set aside tax-free dollars each year for health care expenses not covered by insurance. The PARTICIPANT may use these funds to pay for eligible health care expenses incurred by the PARTICIPANT or the PARTICIPANT’S QUALIFIED DEPENDENTS.
HEALTH BENEFIT PROGRAM means the Group Health Insurance Program that provides group health BENEFITS to eligible STATE and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes. The HEALTH BENEFIT PROGRAM is established, maintained and administered by the BOARD. HIGH DEDUCTIBLE HEALTH PLAN (HDHP) as defined in UNIFORM BENEFITS. HOSPITAL as defined in UNIFORM BENEFITS. IN-NETWORK refers to a provider who has agreed in writing by executing a participation agreement to provide, prescribe or direct health care services, supplies or other items covered under UNIFORM BENEFITS to PARTICIPANTS. The provider's written participation agreement with a CONTRACTOR must be in force at the time such services, supplies or other items covered under UNIFORM BENEFITS are provided to a PARTICIPANT. The CONTRACTOR agrees to give PARTICIPANTS lists of affiliated providers. Some providers require prior authorization by the CONTRACTOR in advance of the services being provided. INPATIENT means a PARTICIPANT admitted as a bed patient to a health care facility or in twenty-four (24)-hour home care. MEDICARE ADVANTAGE means a program defined under Title 18, Part C of the U.S. Social Security Act of 1965, as amended. MEDICARE ADVANTAGE CONTRACTOR means the CONTRACTOR contracted by the DEPARTMENT to provide MEDICARE ADVANTAGE plans for MEDICARE-eligible SUBSCRIBERS. The MEDICARE ADVANTAGE CONTRACTOR is also referred to herein as a CONTRACTOR. Certain terms and conditions herein do not apply to the MEDICARE ADVANTAGE CONTRACTOR and certain terms and conditions herein only apply to the MEDICARE ADVANTAGE CONTRACTOR. These instances are specifically noted herein. Where no such clarification is made, the term or condition shall apply to all CONTRACTORS including the MEDICARE ADVANTAGE CONTRACTOR.

Related to HEALTH BENEFIT PROGRAM

  • Health benefits plan means a benefits plan which pays or

  • Health Benefits means health maintenance organization, insured or self-funded medical, dental, vision, prescription drug and behavioral health benefits.

  • Health benefit plan means a policy, contract, certificate or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.

  • Group health benefit plan means any health care plan, subscription contract, evidence of

  • Basic health benefit plan means any plan offered to an individual, a small group,

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Health plan or "health benefit plan" means any policy,

  • Retiree means any person who has begun accruing a retirement

  • Health insurance plan means any health insurance policy or health benefit plan offered by a health insurer or a subcontractor of a health insurer, as well as Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State. The term includes vision care plans but does not include policies or plans providing coverage for a specified disease or other limited benefit coverage.

  • Medical Benefits means the monthly fair market value of benefits provided to the Employee and the Employee’s dependents under the major medical, dental and vision benefit plans sponsored and maintained by the Company, at the level of coverage in effect for such persons immediately prior to the Employee’s termination of employment date. The “monthly fair market value” of such benefits shall be equal to the monthly cost as if such persons elected COBRA continuation coverage at such time at their own expense.

  • Retirement program means a program of rights and obligations which a county, city, village, or township establishes, maintains, or participates in and which, by its express terms or as a result of surrounding circumstances, does 1 or more of the following:

  • Gap medical benefits means the benefits (if any) payable in respect of medical expenses that are less than, greater than or equal to the schedule fee, provided always that the medical expenses relate to a professional service that:

  • Health Plans means any and all individual and family health and hospitalization insurance and/or self-insurance plans, medical reimbursement plans, prescription drug plans, dental plans and other health and/or wellness plans.

  • Retirement Plans means the retirement income, supplemental executive retirement, excess benefits and retiree medical, life and similar benefit plans providing retirement perquisites, benefits and service credit for benefits at least as great in the aggregate as are payable thereunder prior to a Change in Control;

  • Essential Health Benefits means, under section 1302(b) of the Patient Protection and Affordable Care Act, those health benefits to include at least the following general categories and the items and services covered within the categories: ambulatory patient services; Emergency Services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

  • Medical Benefits Schedule means the Medicare Schedule of Benefits produced by the Department of Health to which all fees and benefits relate for inpatient hospital services.

  • Basic health plan means the plan described under chapter

  • Compensation and Benefits Programs means all compensation and benefit plans, policies, and programs of the Debtors, and all amendments and modifications thereto, applicable to the Debtors’ employees, former employees, retirees, and non-employee directors and the employees, former employees and retirees of their subsidiaries, including all savings plans, retirement plans, health care plans, disability plans, and incentive plans, deferred compensation plans, and life, accidental death, and dismemberment insurance plans.

  • Additional gap medical benefits means the benefits (if any) payable in respect of medical expenses that are more than the schedule fee and which otherwise meet the requirements of the fund’s no or known gap policy, provided always that the medical expenses relate to a professional service that:

  • Health and Welfare Benefits means any form of insurance or similar benefit programs, which may include but not be limited to, medical, hospitalization, surgical, prescription drug, dental, optical, psychiatric, life, or long-term disability.

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Group health insurance coverage means in connection with a group health plan, health insurance

  • Retirement Plan means a plan which provides retirement benefits to you and which is not funded wholly by your contributions. The term shall not include a profit-sharing plan, informal salary continuation plan, registered retirement savings plan, stock ownership plan, 401(K) or a non-qualified plan of deferred compensation.

  • Pension Benefits Act means The Pension Benefits Act of Ontario and regulations thereunder as amended from time to time.

  • Health insurance means protection which provides payment of benefits for covered sickness or injury.