MAPD Plan definition

MAPD Plan means the CMS approved Medicare Advantage plan sponsored, issued, or administered by the MA Health Plan as defined at 42 C.F.R. § 423.4 and includes, but is not limited to, Dual-Eligible Special Needs Plans or D-SNPs as defined in the Medicare Advantage Regulations. Qualified Disabled and Working Individuals (QDWI) means an individual lost their Medicare Part A benefits due to their return to work. They are eligible to purchase Medicare Pat A benefits, have income of 200% FPL or less and resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays the Medicare Part A premiums only. Qualified Medicare Beneficiary (QMB) means an individual who is entitled to Medicare Part A, has income that does not exceed 100% of the Federal Poverty Level (FPL), and whose resources do not exceed twice the Supplemental Security Income (SSI) limit. A QMB is eligible for Medicaid payment of Medicare premiums, deductibles, coinsurance, and co-payments (except for Medicare Part D) (“QMB Medicaid Benefits”). Qualifying Individuals (QI) means an individual is entitled to Medicare Part A, have income of at least 120% FPL, but less than 135% FPL, resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays their Medicare Part B premiums only. Specified Low-Income Medicare Beneficiary (SLMB): An individual entitled to Medicare Part A, has income that exceeds 100% FPL but less than 120% FPL, and resources do not exceed twice the SSI limit and are not otherwise eligible for Medicaid. A SLMB is eligible for Medicaid payment of Medicare Part B premium only. SLMB Plus – SLMBs that are entitled to Medicare Part A, have income of greater than 100% FPL, but less than 120% FPL and resources that do not exceed twice the limits for SSI eligibility, and are also eligible for full Medicaid coverage. Such individuals are entitled to Medicaid payment of the Medicare Part B premium, as well as full State Medicaid benefits.
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MAPD Plan means an individual Medicare Advantage Plan issued by an Insurance Carrier pursuant to a contract with CMS, which does include Medicare Part D prescription drug coverage.‌
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MAPD Plan means the CMS approved Medicare Advantage plan sponsored, issued, or administered by the MA Health Plan as defined at 42 C.F.R. § 423.4 and includes, but is not limited to, Dual-Eligible Special Needs Plans or D-SNPs as defined in the Medicare Advantage Regulations. Qualified Disabled and Working Individuals (QDWI) means an individual lost their Medicare Part A benefits due to their return to work. They are eligible to purchase Medicare Pat A benefits, have income of 200% FPL or less and resources that do not exceed twice the limit for SSI eligibility, and are not otherwise
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Examples of MAPD Plan in a sentence

  • For purposes of this addendum, unless otherwise noted, reference to an "MA-PD Sponsor" or "MA-PD Plan" is deemed to include a cost plan sponsor or a MA private fee-for-service contractor offering a Part D benefit.

  • If an Enrollee is enrolled in an HMO or a Medicare Advantage Prescription Drug (MAPD) Plan Option, this Article may not apply and prescription drug benefits are provided under the applicable insurance policy or contract.

  • These qualifier values will allow pharmacies to identify Medicare MA-PD Plans that offer additional benefits besides Part D covered Drug Products:• The Medicare Advantage (MA) portion of the MA-PD Plan = Benefit Stage Qualifier (393-MV) value of “50” (Not paid under Part D, paid under Part C benefit (for MA-PDPlan).

  • The MA Health Plan has entered into a contract with the Centers for Medicare and Medicaid Services (“CMS”) to provide an MAPD Plan (“MA Agreement”) under Title XVIII and XIX of the Social Security Act, including Medicare Advantage Special Needs Plan (SNPs) that arrange for the provision of Medicare services for individuals who are dually-eligible for both Medicare and Medicaid benefits.

  • In the event that the MAPD Plan has a significant change in its network and must report this change to CMS, it must concurrently report the event to PEIA.

  • Most retired members are receiving benefits under the self-insured PPB Plan A for non-Medicare coverage and the fully-insured MAPD Plan 1 for Medicare coverage.

  • As provided under section 1860D-14 of the Act, full-benefit dual eligible individuals who are institutionalized individuals have no cost sharing for covered Part D drugs under their Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug (MA-PD) Plan.

  • Upon termination of this agreement, or any extension thereto, the MAPD Plan has the duty to continue to provide any reports required by the agreement or any law or regulation.

  • The MAPD Plan selected will be considered part of an Organized Health Care Arrangement as defined in 45 CFR §160.103.

  • These qualifier values will allow pharmacies to identify Medicare MA- PD Plans that offer additional benefits besides Part D covered Drug Products: • The Medicare Advantage (MA) portion of the MA-PD Plan = Benefit Stage Qualifier (393-MV) value of “50” (Not paid under Part D, paid under Part C benefit (for MA-PD Plan).

Related to MAPD Plan

  • Flexi Plan means any individual indemnity hospital insurance plan under the VHIS framework with enhancement(s) to any or all of the protections or terms and benefits that the Standard Plan provides to the Policy Holder and the Insured Person, subject to certification by the Government. Such plan shall not contain terms and benefits which are less favourable than those in the Standard Plan, save for the exception as may be approved by the Government from time to time.

  • EHC plan means an Education, Health and Care plan made under sections 37(2) of the Children and Families Act 2014.

  • Supplemental Plan means a written plan for a child outlining the agency's plan to locate a permanent placement for the child and which may be developed concurrently with the case plan.

  • Company 401(k) Plan shall have the meaning set forth in Section 6.09(e).

  • Separation Plan means the Company’s Separation Plan Amended and Restated Effective August 13, 2006, as may be amended from time to time or any successor plan, program, arrangement or agreement thereto.

  • BCDR Plan means the plan consisting of general business continuity and disaster recovery principles, the Business Continuity Plan and Disaster Recovery Plan as further described in paragraph 1.2 of Schedule 2- 14.

  • Program Plan means the tobacco settlement program plan dated February 14, 2001, including exhibits to the program plan, submitted by the authority to the legislative council and the executive council, to provide the state with a secure and stable source of funding for the purposes designated by section 12E.3A and other provisions of this chapter.

  • Profit Sharing Plan means a profit-sharing plan that is qualified pursuant to 26 U.S.C. § 401 of the Internal Revenue Code and subject to the Employee Retirement Income Security Act, and which provides for employer contributions in the form of cash, but not in the form of stock or other equity interests in a Medical Marijuana Business.

  • Plan means any employee pension benefit plan (other than a Multiemployer Plan) subject to the provisions of Title IV of ERISA or Section 412 of the Code or Section 302 of ERISA, and in respect of which the Borrower or any ERISA Affiliate is (or, if such plan were terminated, would under Section 4069 of ERISA be deemed to be) an “employer” as defined in Section 3(5) of ERISA.

  • Deferral Plan means the UGI Corporation 2009 Deferral Plan.

  • Basic health plan model plan means a health plan as required in RCW 70.47.060(2)(e).

  • Commercialization Plan has the meaning set forth in Section 6.2.

  • Thrift Plan means the Financial Institutions Thrift Plan, a qualified and tax-exempt defined contribution plan and trust under Sections 401(a) and 501(a) of the Code, as adopted by the Bank.

  • Restoration Plan means all technical and organisational measures necessary for the restoration of the system back to normal state;

  • RBC plan means a comprehensive financial plan containing the elements specified in K.S.A. 40-2c06, and amendments thereto. If the commissioner rejects the RBC plan, and it is revised by the insurer, with or without the commissioner's recommendation, the plan shall be called the "revised RBC plan."

  • Transition Plan means a transition plan, acceptable to the LHIN that indicates how the needs of the HSP’s clients will be met following the termination of this Agreement and how the transition of the clients to new service providers will be effected in a timely manner; and

  • Supply Plan has the meaning set forth in the CAISO Tariff.

  • HACCP plan means a written document that delineates the formal procedures for following the hazard analysis and critical control point principles developed by the National Advisory Committee on Microbiological Criteria for Foods.

  • Area Plan or “multiyear area plan” means a document, developed in accordance with the uniform area plan format and IAPI issued by the department, that is submitted to the department every four years, with annual updates, by an AAA in order to receive subgrants from the department’s grants.

  • Statutory Plan means a plan required in terms of any legislation, including but not limited to, any structure plan, land use plan, zoning scheme, integrated development plan, water services plan, skills development plan and employment equity plan;

  • Health benefits plan means a benefits plan which pays or

  • Dental plan means any dental insurance policy, including those of nonprofit health service plans, and those of commercial group, blanket, and individual policies, any subscriber contracts issued by Health Maintenance Organizations (HMOs), and any other established programs under which the insured may make a claim. The term Dental Plan includes coverage under a governmental plan, or coverage required to be provided by law. This does not include a State plan under Medicaid (Title XIX, Grants to States for Medical Assistance Programs, of the United States Social Security Act, as amended from time to time.)

  • Buyer 401(k) Plan has the meaning set forth in Section 6.01(h).

  • Redevelopment Plan means the “Lincoln Center Redevelopment Plan” passed, adopted and approved by the City pursuant to the Resolution, and shall include any amendment of said Redevelopment Plan heretofore or hereafter made by the City pursuant to law.

  • 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.

  • Parent Plan means an Employee Benefit Plan sponsored, maintained, or contributed to by Parent or its Affiliates or with respect to which Parent or its Affiliates have any liability.