Medicare Product definition

Medicare Product means any of the following:
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Medicare Product is any Medicare Advantage Plan, Medicare Advantage Prescription Drug Plan, or stand- alone Prescription Drug Plan that may now or in the future be offered to individual Medicare beneficiaries by BCBST. Medicare Product does not include any Medicare supplement insurance products offered by BCBST.
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Medicare Product refers to those programs and health benefit arrangements offered by Health Plan or another Company in connection with one or more of the following Medicare product types that is administered, sponsored or regulated by the federal government (or any agency, department or division thereof) on its own or jointly with a State that administers or regulates such program or plan (each a “Medicare Product Type”): a non-Dual Eligible Special Needs Plan Medicare Advantage plan (“MA Plan”); a Medicare Advantage prescription drug plan (“MA-PD Plan”); a Dual Eligible Special Needs Plan (“DSNP Plan”); a Capitated Financial Alignment Demonstration (“MMP Plan”) plan or program (e.g., a plan or program adopted or established under the Affordable Care Act of 2010, to test new service delivery and payment models for people dually eligible for Medicare and Medicaid, including any regulations or CMS pronouncements and any future Attachments); or other Medicare Product Types. The Medicare Product includes those Coverage Agreements entered into, issued or agreed to by a Payor under which a Company furnishes administrative services or other services in support of a Medicare Product. The Medicare Product does not apply to any Coverage Agreements that are specifically covered by another Product Attachment to the Agreement. This Attachment applies only to the provision of health care services, supplies or accommodations (including Covered Services) to Covered Persons enrolled in the Medicare Product. Provider acknowledges that it will participate in each Medicare Product Type for which a Compensation Schedule(s) is attached to this Medicare Product Attachment.
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Examples of Medicare Product in a sentence

  • A sale is considered an Initial Sale if the member is aging‐in, is new to Medicare, or enrolls from Original Medicare into a Medicare Product.

  • A Rapid Disenrollment will result in Humana recovering from the Producer any commission paid to Producer related to the Medicare Product.

  • A sale of a Medicare Product is considered an Unlike Plan Type Change if a member moves from MA or MAPD to PDP only, moves from PDP only to MA or MAPD, moves from a section 1876 cost plan to MA or MAPD, or moves from a section 1876 cost plan to PDP.

  • The pro‐rated charge‐back rule applies to all years of Medicare Product membership by the member.

  • Humana will recover from Producer any commissions paid to Producer for the sale of a Medicare Product that is not a Qualified Enrollment.

  • Members enrolled through Producer who voluntarily or involuntarily disenroll from a Humana Medicare Product before the end of the initial plan year and are not considered rapid disenrollments as described above, are considered long term disenrollments and will result in a recovering pro‐rated commissions equal to those months the member was not enrolled on the Medicare Product (e.g. a member ages in effective April 1st.

  • This section provides additional detail on Medicare Product business in Utah.

  • Note that, per CMS guidelines, Humana may only pay commission for the months the member is actually enrolled, so the commission payment will be pro‐rated based on the number of months that the Medicare Product would be effective the rest of the plan year.

  • For example, if a member enrolls in a Medicare Product effective October 1, November 1, or December 1, and disenrolls during the same enrollment year unrelated to the Annual Election Period and effective on or before January 1 of the following year.

  • In the event that a Medicare Product Enrollee changes plans, Commissions shall be payable (or not payable) in accordance with Appendix A.


More Definitions of Medicare Product

Medicare Product means the forms of medicare coverage under which medicare beneficiaries may obtain coverage from a risk- bearing entity, including a medicare advantage plan;
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Medicare Product means any of the following: a “prescription drug plan”, as such term is defined under Medicare Part D at 42 USC § 1395w-151(a)(14) (“Medicare Prescription Drug Plan”; a “Medicare supplemental policy”, as such term is defined under Medicare Part E at 42 USC § 1395ss(g)(1) (“Medicare Supplement Policy”); the health benefits coverage provided under Medicare Part C at 42 USC §§ 1395w-21 et seq. (“Medicare Advantage Plan”); or a Medicare Advantage Plan that provides qualified prescription drug coverage, as described under Medicare Part D at 42 USC § 1395w-101(a)(3)(C) (“Medicare Advantage‐ Prescription Drug Plan”).
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Medicare Product means one or more health benefits programs offered by Company to Groups or Individuals. The Medicare Product or Medicare Products applicable to this Agree- ment are set forth in the commission sched- ules attached as Exhibit C (“Commission Schedules”). References in this Agreement to CMS are limited to those Medicare Products that Company offers pursuant to one or more contracts with CMS.
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Related to Medicare Product

  • Child Care Program means a person or business that offers child care.

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Licensed health care practitioner means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets requirements prescribed by the Secretary of the Treasury.

  • Licensed health care professional means a person who possesses a professional medical license that is valid in Oregon. Examples include, but are not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant (PA), or occupational therapist (OT).

  • Federal Health Care Program means any “federal health care program” as defined in 42 U.S.C. § 1320a-7b(f), including Medicare, state Medicaid programs, state CHIP programs, the Veterans Administration, TRICARE and similar or successor programs with or for the benefit of any Governmental Authority, and in each case any third party payor administering such programs.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • FDA means the United States Food and Drug Administration and any successor agency thereto.

  • Medical marijuana product means a product that contains cannabinoids that have been extracted from plant material or the resin therefrom by physical or chemical means and is intended for administration to a licensed patient, including but not limited to concentrates, oils, tinctures, edibles, pills, topical forms, gels, creams, and other derivative forms, except that this term does not include live plant forms.

  • Drug abuse means any pattern of pathological use of drugs that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn.

  • Respiratory care practitioner means an individual who practices respiratory care.

  • Tobacco product means any substance containing tobacco leaf, including but not limited to, cigarettes, cigars, pipe tobacco, hookah tobacco, snuff, chewing tobacco, dipping tobacco, bidis, blunts, clove cigarettes, or any other preparation of tobacco; and any product or formulation of matter containing biologically active amounts of nicotine that is manufactured, sold, offered for sale, or otherwise distributed with the expectation that the product or matter will be introduced into the human body by inhalation; but does not include any cessation product specifically approved by the U.S. Food and Drug Administration for use in treating nicotine or tobacco dependence.

  • Pre-Licensed Therapist means an individual who has obtained a Master’s Degree in Social Work or Marriage and Family Therapy and is registered with the BBS as an Associate CSW or MFT Intern acquiring hours for licensing. An individual’s registration is subject to regulations adopted by the BBS.

  • in vitro diagnostic medical device means any medical device which is a reagent, reagent product, calibrator, control material, kit, instrument, apparatus, equipment, software or system, whether used alone or in combination, intended by the manufacturer to be used in vitro for the examination of specimens, including blood and tissue donations, derived from the human body, solely or principally for the purpose of providing information:

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • Marijuana product means marijuana as defined in 50-32-101 and marijuana-infused products

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Antipsychotic medications means that class of drugs

  • Health care practitioner means an individual licensed

  • Pharmacy means prescribed drugs and medicines dispensed by a pharmacist and/or travel and allergy vaccines dispensed by a pharmacist or doctor.

  • Tobacco products means cigars, cigarettes, cheroots, stogies, periques, granulated, plug cut, crimp cut, ready rubbed, and other smoking tobacco, snuff, snuff flour, moist snuff, cavendish, ping and twist tobacco, fine-cut and other chewing tobaccos, shorts, refuse scraps, clippings, cuttings and sweepings of tobacco, and other kinds and forms of tobacco, prepared in such manner as to be suitable for chewing or smoking in a pipe or otherwise, or both for chewing and smoking.

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Product means any deliverable under the Contract, which may include commodities, services, technology or software.

  • Marijuana products means concentrated marijuana products and marijuana products that are comprised of marijuana and other ingredients and are intended for use or consumption, such as, but not limited to, edible products, ointments, and tinctures.

  • Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • medicinal product means any substance or combination of substances presented for treating or preventing disease in human beings or animals and any substance or combination of substances which may be administered to human beings or animals with a view to making a medical diagnosis or to restoring, correcting or modifying physiological functions in humans or in animals;

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.