Member eligibility file definition

Member eligibility file means a data file containing demographic information for each individual member eligible for medical benefits, for one or more days of coverage at any time during the reporting month.
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Member eligibility file means a data file composed of demographic information for each individual Member eligible for medical or pharmacy benefits as specified in the RIAPCD Technical Specification Manual, for one or more days of coverage at any time during the reporting month.
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Member eligibility file means a data file that contains demographic information for each individual member eligible for medical or pharmacy benefits for one or more days of coverage at any time during the reporting period.
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Examples of Member eligibility file in a sentence

  • IEHP utilizes the monthly Member eligibility file sent by Department of Health Care Services (DHCS) on information regarding the “Other Health Coverage” for the Medi- Cal Medicare Members.B. A Member is legally obligated to report information about Other Health Coverage.C. Members or other payers have up to thirty-six (36) months from the date on which the prescription for a covered Part D drug was filled to seek reimbursement from IEHP.

  • If a Member requests a change from one dental plan to another, the change will be prospective, and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(c) HHSC Enrollment Broker enrolls and disenrolls Members from dental plans.

  • If a Member requests a change, the change will be prospective, and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(b) In cases where a Member loses Medicaid eligibility, if Medicaid eligibility is re-instated or re-established within 6 months from the date of loss, HHSC will retroactively restore a Member's managed care enrollment to avoid a gap in coverage.

  • If a Member requests a change from one dental plan to another, the change will be prospective and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(c) HHSC or the CHIP Administrative Services Contractor enrolls and disenrolls Members from dental plans.

  • If a Member requests a change, the change will be prospective and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.

  • If a Member requests a change, the change will be prospective and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(b) In cases where a Member loses Medicaid eligibility, if Medicaid eligibility is re-instated or re- established within six months from the date of loss, HHSC will retroactively restore a Member's managed care enrollment to avoid a gap in coverage.

  • CCHP had to reconcile numerous HHSC Member eligibility file errors, faced initial resistance and no shows from some families, complied with HHSC’s request to not cause undue stress by aggressive pursuit to speak or meet with Members/LARs when they were hesitant to do so, and adjusted to HHSC changes in the prioritization of Members for early contact and assessment.

  • PIHP will provide Administrator with a monthly electronic Member eligibility file, full build and daily updates thereto, in a manner and using processes mutually agreed upon by the parties.

  • Member eligibility file" means a data file containing demographic information for each individual member eligible for medical, pharmacy, or dental benefits for one or more days of coverage at any time during the reporting month as well as any retrospective updates that correspond to previously submitted eligibility data.

  • If ESI must create or modify a Member eligibility file by manually entering employee data or if the format is inconsistent with ESI’s standard requirements, there will be a $1.00 per Member implementation fee.


More Definitions of Member eligibility file

Member eligibility file means a data file con- taining demographic information for each individual member eligible for medical or pharmacy benefits for one or more days of coverage at any time during the reporting month.
Sample 1Sample 2
Member eligibility file means a data file containing demographic information for each individual member eligible for medical, pharmacy, or dental benefits for one or more days of coverage at any time during the reporting month as well as any retrospective updates that correspond to previously submitted eligibility data. The term also includes benefits attributed and associated effective periods.
Sample 1
Member eligibility file means a data file containing
Sample 1Sample 2
Member eligibility file means a data file composed of demographic information for each individual Member eligible for medical or pharmacy benefits as specified in the RIAPCD Technical Specification Manual, for one
Sample 1

Related to Member eligibility file

  • Eligibility Waiting Period means the continuous length of time you must be in Active Employment in an eligible class to reach your Eligibility Date.

  • Eligibility Service of an employee means the period or periods of service credited to him under the provisions of Article II for purposes of determining his eligibility to participate in the Plan as may be required under Article III or Article VI.

  • Eligibility Date means the date you become eligible for insurance under this plan. The Eligibility Requirements are shown in the Schedule of Benefits.

  • Year of Eligibility Service means where an Employer designates a one or two 12-consecutive-month eligibility waiting period, an Employee must complete at least 1,000 Hours of Employment during each 12-consecutive-month period (measured from his date of Employment and then as of the first day of each Plan Year commencing after such date of Employment); provided, however, if an Employee is credited with 1,000 Hours of Employment in both the initial eligibility computation period and the first Plan Year which commences prior to the first anniversary of the Employee's employment commencement date, the Employee will be credited, for eligibility purposes, with two Years of Eligibility Service. Where an Employer designates an eligibility waiting period of less than 12 months, an Employee must, for purposes of eligibility, complete a required number of hours (measured from his date of Employment and each anniversary thereafter) which is arrived at by multiplying the number of months in the eligibility waiting period requirement by 83 1/3; provided, however, if an Employee completes at least 1,000 Hours of Employment within the 12 month period commencing on his Employment commencement date or during any Plan Year commencing after such Employment commencement date, such Employee will be treated as satisfying the eligibility service requirements.

  • Eligibility means the decision as to whether an individual qualifies, under financial and nonfinancial requirements, to receive program benefits.

  • Eligibility Conditions means the eligibility conditions specified in the Act and the Rules including all the eligibility conditions listed in Clause [5] of the Tender Document.

  • Top Heavy Group means an Aggregation Group in which, as of the Determination Date, the sum of:

  • completed year of service means continuous service for one year;

  • Eligibility Determination means an approval or denial of eligibility and a renewal or termination of eligibility as set forth in OAR 410-200-0015;¶

  • Eligibility Record Date means a record date that is 1 year or more before the adoption of a plan of conversion by a credit union board and is set forth in a plan of conversion for determining eligible members of a converting credit union.

  • DWAC Eligible means that (a) the Common Stock is eligible at DTC for full services pursuant to DTC’s Operational Arrangements, including without limitation transfer through DTC’s DWAC system, (b) the Company has been approved (without revocation) by the DTC’s underwriting department, (c) the Transfer Agent is approved as an agent in the DTC/FAST Program, (d) the Conversion Shares are otherwise eligible for delivery via DWAC, and (e) the Transfer Agent does not have a policy prohibiting or limiting delivery of the Conversion Shares via DWAC.

  • Eligibility Requirements means, with respect to any Person, that such Person (i) has total assets (in name or under management) in excess of $600,000,000 and (except with respect to a pension advisory firm or similar fiduciary) capital/statutory surplus or shareholder’s equity of $250,000,000 and (ii) is regularly engaged in the business of making or owning commercial real estate loans or operating commercial mortgage properties.

  • Basic Plan means as to any Member or Vested Former Member the defined benefit pension plan of the Company or an Affiliated Employer intended to meet the requirements of Code Section 401(a) pursuant to which retirement benefits are payable to such Member or Vested Former Member or to the Surviving Spouse or designated beneficiary of a deceased Member or Vested Former Member.