Member Benefit Plan definition

Member Benefit Plan means the applicable Medicaid plan through which a Member is covered. Non-Covered Services means those services which exceed any limit on, or are outside the scope of health care coverage of Member Benefit Plans.
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Examples of Member Benefit Plan in a sentence

  • The preceding provisions do not prohibit the collection of Copayments, Coinsurance and Deductibles from Members, as set forth in the applicable Member Benefit Plan.

  • Such audit may include tests of the records and such other auditing procedures or medical reviews, including but not limited to statistically valid sampling techniques of Participating Provider, as considered necessary to ensure that Participating Provider has complied with the terms and conditions of this Agreement and that payment has been made according to the terms and conditions of the applicable Member Benefit Plan.

  • Health Options agrees to pay Participating Provider directly for all Covered Services under the Member Benefit Plan and in accordance with applicable benefit policies without Participating Provider requiring an Assignment of Benefits from the Member and without regard to any Member's stated request to receive payment directly from Health Options.

  • Participating Provider agrees to xxxx Health Options directly for all Medically Necessary Covered Services under the Member Benefit Plan and to accept payment pursuant to the lesser of Participating Provider’s charge or Health Options’ Payment Schedule.

  • Creative teaching and learning tries to find solutions to the challenges occurring due to the cultural and socioeconomic diversity of the students.

  • The Employer shall remit premiums and / or matching contributions to the University of Waterloo in order to maintain, health, welfare, and pension benefits through the University of Waterloo Member Benefit Plan (see the University of Waterloo – Faculty Association at the University of Waterloo Memorandum of Agreement, Pension and Benefits, Article 11), as amended from time to time.

  • IPA shall implement cash management policies in keeping with sound financial management practices in order to ensure timely and accurate payment to all providers who provide Medically Necessary IPA Services to IPA Members, acknowledging that WellCare is responsible for the final determination of benefit payments to be made under an IPA Member Benefit Plan.

  • Before reporting wages and service for the first time for an employee new to your reporting unit you must check the Member Benefit Plan link on the employer reporting web site to find out if the new employee is already a MPSERS member or is new to the MPSERS system.

  • Follow the information displayed on the Member Benefit Plan screen and report wages and contributions on DTL2 and/or DTL4 records as dictated by the benefit plan displayed for this employee.

  • WHEN THE PLAN IS PRIMARY, Your Participating Provider can: • Submit to the insurance company on a secondary basis at Participating Provider’s usual and customary rates, but indicating the out-of-pocket Benefit Plan Copayment for procedures performed.• Accept payment from the secondary insurance company equal to the Member Benefit Plan Copayment.• Only bill the Member if the insurance pays an amount less than the Benefit Plan Copayment.

Related to Member Benefit Plan

  • Seller Benefit Plan means each Benefit Plan sponsored, maintained or contributed to by Seller or any of its Subsidiaries or with respect to which Seller or any of its Subsidiaries is a party and in which any Employee is or becomes eligible to participate or derive a benefit.

  • Seller Benefit Plans has the meaning set forth in Section 4.8(a).

  • Buyer Benefit Plans has the meaning set forth in Section 6.10(f).

  • Purchaser Benefit Plans has the meaning set forth in Section 8.7(d).

  • Non-U.S. Benefit Plan has the meaning set forth in Section 3.20(a).

  • 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 Benefit Plan means an Employee Benefit Plan sponsored, maintained, or contributed to (or required to be contributed to) by Parent or any of its Subsidiaries, or under or with respect to which Parent or any of its Subsidiaries has any current or contingent liability or obligation.

  • Qualified Benefit Plan has the meaning set forth in Section 3.20(c).

  • Company Benefit Plan has the meaning specified in Section 4.13(a).

  • Foreign Benefit Plan means any Employee Benefit Plan established, maintained or contributed to outside of the United States of America or which covers any employee working or residing outside of the United States.

  • Welfare Benefit Plan means each welfare benefit plan maintained or contributed to by the Company, including, but not limited to a plan that provides health (including medical and dental), life, accident or disability benefits or insurance, or similar coverage, in which Executive was participating at the time of the Change in Control.

  • Business Benefit Plan means each Benefit Plan that is contributed to, sponsored, maintained or entered into by Seller or a Retained Subsidiary, a Purchased Subsidiary or any Affiliate of any of them for the benefit of any Business Employee.

  • Pension Benefit Plan means at any time any employee pension benefit plan (including a Multiple Employer Plan, but not a Multiemployer Plan) which is covered by Title IV of ERISA or is subject to the minimum funding standards under Section 412 of the Code and either (i) is maintained by any member of the Controlled Group for employees of any member of the Controlled Group; or (ii) has at any time within the preceding five years been maintained by any entity which was at such time a member of the Controlled Group for employees of any entity which was at such time a member of the Controlled Group.

  • Company Employee Benefit Plan means each Employee Benefit Plan that is maintained, sponsored or contributed to (or required to be contributed to) by any of the Group Companies or under or with respect to which any of the Group Companies has any Liability.

  • Parent Benefit Plans has the meaning set forth in Section 5.07(b).

  • Benefit Plan means any of (a) an “employee benefit plan” (as defined in ERISA) that is subject to Title I of ERISA, (b) a “plan” as defined in Section 4975 of the Code or (c) any Person whose assets include (for purposes of ERISA Section 3(42) or otherwise for purposes of Title I of ERISA or Section 4975 of the Code) the assets of any such “employee benefit plan” or “plan”.

  • Company Benefit Plans has the meaning set forth in Section 3.16(a).

  • Company Employee Plan means any plan, program, policy, practice, contract, agreement or other arrangement providing for compensation, severance, termination pay, deferred compensation, performance awards, stock or stock-related awards, fringe benefits or other employee benefits or remuneration of any kind, whether written or unwritten or otherwise, funded or unfunded, including without limitation, each "employee benefit plan," within the meaning of Section 3(3) of ERISA which is or has been maintained, contributed to, or required to be contributed to, by the Company or any Affiliate for the benefit of any Employee, or with respect to which the Company or any Affiliate has or may have any liability or obligation;

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

  • Defined Benefit Plan means either a plan described in Section 3(35) of ERISA or a plan subject to the minimum funding standards set forth in Section 302 of ERISA and Section 412 of the Code.

  • Company Plan means any Benefit Plan: (i) under which any current or former director, officer, employee, consultant or independent contractor of the Company has any present or future right to benefits and that is maintained, sponsored or contributed to by the Company; or (ii) with respect to which the Company has any Liability.

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

  • Compensation and Benefit Plans has the meaning set forth in Section 5.03(m)(i).

  • Employee Welfare Benefit Plan has the meaning set forth in ERISA Section 3(1).

  • Parent Employee Plan means any plan, program, policy, practice, contract, agreement or other arrangement providing for compensation, severance, termination pay, performance awards, stock or stock-related awards, fringe benefits or other employee benefits or remuneration of any kind, whether written or unwritten or otherwise, funded or unfunded, including without limitation, each "EMPLOYEE BENEFIT PLAN," within the meaning of Section 3(3) of ERISA which is maintained, contributed to, or required to be contributed to, by Parent or any Affiliate for the benefit of any Parent Employee;

  • Foreign Benefit Arrangement means any employee benefit arrangement mandated by non-U.S. law that is maintained or contributed to by any Credit Party or any of its Subsidiaries.