Health plan member definition

Health plan member means any person participating in a state group health insurance plan, a TRICARE supplemental insurance plan, or a health maintenance organization plan under the state group insurance program, including enrollees and covered dependents thereof.
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Examples of Health plan member in a sentence

  • Deductible means fixed dollar amounts that an MA Health plan member normally must pay out-of- pocket before the costs of services are covered by an MA Health Plan.

  • Nebraska DHHS MLTC Medicaid IDYou must have a Nebraska Medicaid provider ID number to render services for a Nebraska Heritage Health plan member and receive payment from us.

  • Health plan member eligibility may be an issue if a patient does not have coverage on the date of service, and may include issues regarding coordination of benefits if the patient has coverage with more than one insurance plan.

  • The Passport program lets members access covered services with participating providers in the Passport service area at in-network costs.Still, the best part is this: As a Peoples Health plan member, you enjoy the quality that comes from people who really care.

  • Health plan member experience with point-of-service prescription step therapy.

  • The policy is to be written on a non-reporting basis, and in an amount not less than the total value of the Premises (less the value of such uninsurable items as land, site preparation, grading, paving, and parking lots).

  • Health plan member with 1 AGE encounter during the study period who meets enrollment criteria; members can have multiple events.

  • On the cover: Barbara E., Peoples Health plan member What isPeoples Health?The choice of more than 75,000 Medicare beneficiaries in Louisiana.

  • If the payment was made for the wrong Member, the claim must be voided and a new claim must be submitted.4. Health plan member ID numberEnter the Plan Member ID number as it appears on the EOB.

Related to Health plan member

  • Plan Member means each Member any of the assets of which are subject to any Plan Governing Law.

  • Health plan issuer means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefit plan, including a sickness and accident insurance company, a health insuring corporation, a fraternal benefit society, a self-funded multiple employer welfare arrangement, or a nonfederal, government health plan. “Health plan issuer” includes a third party administrator to the extent that the benefits that such an entity is contracted to administer under a health benefit plan are subject to the insurance laws and rules of this state or subject to the jurisdiction of the superintendent. The “Health plan issuer” is also called the Administrator in this Benefit Booklet.

  • Staff member means a staff member as defined in section 1(1) of the Public Service Act, 1995 (Act No. 13 of 1995);

  • Pharmacy benefits manager means a person that performs pharmacy benefits management.

  • Teaching staff member means an employee who holds a position for which a certificate issued by the New Jersey State Board of Examiners is required.

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

  • Team Member means an individual who is allowed to access the Cloud Service but is only granted membership in groups associated with “Team Member” permissions for the Cloud Service.2

  • Executive Member means any elected member of the authority appointed to the executive of that authority;

  • Pharmacy benefits management means the administration or management of prescription drug

  • Large employer means, in connection with a group health plan or health insurance coverage with

  • county executive committee member means the county executive committee member responsible for matters relating to land;

  • Association Member means an owner or a member of an association.

  • Executive manager means an individual employed by a new motor vehicle dealer in an executive capacity and who has a written employment agreement with the dealer that includes a right for the executive manager to purchase a controlling interest in the dealership at a future time or on the death or incapacity of the dealer.

  • Eligible Member means an employee who is enrolled in one of the designated benefits plans for which you offer participation in the wellness incentive program prior to the end of the first six months of the policy year and who remains enrolled in one of the designated benefits plans at the end of the policy year. Eligible Member also means the employee’s dependents to the extent that dependents are eligible to participate in the Blue Cross and Blue Shield wellness incentive program.) To qualify for a group wellness incentive award, you must meet the following program participation conditions: • You are a group eligible to offer the program as determined by Blue Cross and Blue Shield; and • You elect to offer the Blue Cross and Blue Shield wellness incentive program to your Members who are eligible to participate in the program at the start of your policy year and you continue the program for eligible Members through the end of the policy year; and • At least 20% of your Members who are eligible for the program must participate in the program during the policy year in which you offer the wellness incentive program; and • This Agreement is not be terminated before the end of the policy year in which you offer the wellness incentive program. When you offer a Blue Cross and Blue Shield wellness incentive program, Blue Cross and Blue Shield will determine if you qualify for a group incentive award within 90 days after the end of the policy year. Your group wellness incentive award will be calculated as a percentage of the total medical insurance premium you paid for the policy year for benefits plans for which you offer wellness incentive program participation, excluding any premium payments that are received by Blue Cross and Blue Shield after the end of the policy year. The percentage used to calculate your wellness incentive award will vary depending on how many of your eligible Members participate in the program during the policy year as follows: 1.25% when 20% to 49% of eligible Members participate; or 2.5% when 50% to 79% of eligible Members participate; or 7.5% when 80% to 100% of eligible Members participate. For the purpose of calculating your group wellness incentive award, an eligible Member who earns his or her individual maximum member wellness incentive payment in the policy year is considered to have participated in the program for that policy year. If you qualify for a group incentive award, Blue Cross and Blue Shield will issue the incentive amount to you (by means of a credit and/or a check) once the incentive amount has been calculated. You are solely responsible for determining whether you have any obligation to distribute all or part of your group wellness incentive award to your employees, or to credit a portion of your group wellness incentive award toward their benefits, or otherwise to notify them of your group wellness incentive award. You agree to indemnify and hold Blue Cross and Blue Shield harmless from any and all actions that may be brought against you or Blue Cross and Blue Shield due to your failure to provide any required distribution of, credit, or notification about, your group wellness incentive award to your employees.

  • Bank Member means Standard Chartered PLC or any of its Affiliates and "Group" means all Bank Members.

  • Pharmacy benefit manager means a person, business or other

  • Former Member means a member that has withdrawn from a qualified authority under this section or a prior member of a qualified authority that has been dissolved under this section.

  • flight crew member means a licensed crew member charged with duties essential to the operation of an aircraft during a flight duty period;

  • Employee Member means a member of the “Bargaining Unit”.

  • Executive Management means the CEO and the CFO for purposes of administering this Plan.

  • Designated Employer Representative (DER) means a designated school district representative authorized to take immediate action to remove employees from safety-sensitive duties, to make required decisions in the testing and evaluation process, and to receive test results and other communications for the school district.

  • Participating member means a member who is required to make mandatory contributions by the applicable retirement act to his or her health reimbursement account.

  • crew member means a person assigned by an operator to duty on an aircraft during a flight duty period;

  • Participating Employer means any trade or business (whether or not incorporated) which adopts this Plan with the consent of the Company identified in the Adoption Agreement.

  • Deferred member means a person who elected to receive deferred vested retirement

  • Participating physician means a physician licensed in Virginia to practice medicine, who practices