Medicare Member definition

Medicare Member means a Member who is eligible to receive Covered Services under a Payer Plan that is offered under the Medicare Advantage Program.

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Medicare Member means a Health Plan's Member who is enrolled in a Medicare+Choice plan through Health Plan. PBM and PBM Contracting Provider compliance with the M+C Contract specifically includes, but is not limited to, the following requirements:

Medicare Member means any Member enrolled in HMO who is entitled to benefits under the Medicare Risk Contract (hereinafter defined).

Examples of Medicare Member in a sentence

• If Member is eligible for Medicare, or during the term of this Agreement become eligible for Medicare, Member will be required to annually sign a Medicare opt-out agreement form.

• Provider shall not deny, limit, or condition the furnishing of benefits to a Medicare Member on the basis of any factor that is related to health status, including, but not limited to the following: (i) medical condition, including mental as well as physical illness; (ii) claims experience; (iii) receipt of health care; (iv) medical history; (v) genetic information; (vi) evidence of insurability, including conditions arising out of acts of domestic violence; or (vii) disability.

• Subject to and in accordance with the foregoing, Provider shall make available to government agencies and accreditation organizations all Medicare Member medical information required for assessing the quality of care or investigating Medicare Member’s grievances or complaints.

• Upon receipt of notification of ineligibility of a Medicare Member, Provider shall use reasonable efforts (i) to advise such Medicare Member of alternative health care providers, programs or arrangements, if any, available to such Medicare Member; and (ii) to assist in the transfer of such Medicare Member whose responsibility for treatment is assumed by another health care provider.

• PBM and PBM's employees and agents shall, and shall require PBM Contracting Providers to, maintain the confidentiality of all Medicare Member records in accordance with the applicable laws and regulations, and shall safeguard Medicare Members' privacy.

• Provider agrees to refund any amounts incorrectly collected from a Medicare Member (or from others on behalf of a Medicare Member), and to pay any other amounts due to a Medicare Member (or others on a Medicare Member’s behalf), in accordance with the provisions of 42 C.F.R. § 422.309, as may be amended from time to time.

• IPA and IPA Physicians have the obligation to and agree to notify HUMANA immediately of the name of any Medicare Member or former Medicare Member treated by a IPA Physician or any other person covered by this provision.

• HUMANA agrees with IPA and IPA Physicians that this paragraph shall not be applicable in the case of any Medicare Member who disenrolls and is treated by a IPA Physician or anyone else on a non-prepaid and non-capitated fee-for-service basis as a private patient.

• Unless otherwise authorized by Company in writing, all services provided by Producer and all services performed by any Downstream Entity that is performing Medicare-related work and/or receiving, processing, transferring, handling, storing, or accessing Medicare Member Protected Health Information under this Agreement must be performed within the United States, the District of Columbia, or the United States territories.

• However, Provider agrees that Payer shall have sole and ultimate authority to terminate a Medicare Member’s coverage, and to notify the Medicare Member of his/her termination.

More Definitions of Medicare Member

Medicare Member means a Member under the federal Medicare Program, that has contracted with an HMO Subsidiary to administer Covered Services under such Medicaid program.

Medicare Member means a member of the WellPath 65 Health Plan, enrolled pursuant to WellPath's Medicare Contract with HCFA. Except as specified in this Medicare Addendum, all provisions of the Agreement applicable to Members shall apply to Medicare Members.

Medicare Member means a person who is enrolled in HMO's Medicare Program. The term "Member" as used in the Agreement shall include a Medicare Member.

Medicare Member means a Member eligible for benefits through the QR-PDP in accordance with the Medicare Drug Rules as identified by Sponsor through the Eligibility Files.

Medicare Member means shall mean any person who is eligible for Medicare enrollment by virtue of attaining age sixty-five (65) or older, for whom Medicare has the primary payment responsibility for hospital and medical care, who has enrolled in a Medicare Plan Option under SECTION II, and who must be:‌