Member or Enrollee definition

Member or Enrollee means a person who: is entitled to benefits under Title XIX of the Social Security Act and the Texas Medical Assistance Program (Medicaid), is in a Medicaid eligibility category included in the STAR Program, and is enrolled in the STAR Program.
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Member or Enrollee. A Medicare Advantage eligible individual who has enrolled in or elected coverage through a Medicare Advantage Organization.
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Member or Enrollee shall have the meaning set forth in Exhibit D, Schedule 1 of this Exhibit D.
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Examples of Member or Enrollee in a sentence

  • Member or Enrollee: a Medicare Advantage eligible individual who has enrolled in or elected coverage through a Medicare Advantage Organization.

  • Member or Enrollee: a Potential Member who has enrolled with CenCal Health.

  • Member or Enrollee: a Potential Member who has enrolled with CenCal Health.Potential Member or Potential Enrollee: a Medi-Cal recipient who resides in CenCal Health’s service area and is subject to mandatory enrollment, or who may voluntarily elect to enroll, but is not yet enrolled, in a Medi-Cal managed care health plan, and is in one of the aid codes specified by DHCS.

  • The Parties expressly acknowledge and agree that Tria, in the performance of the duties described in this Agreement, is not exercising any discretionary authority or discretionary control with respect to the Plan or any Plan Sponsor, and Tria is not a fiduciary within the meaning of federal and state laws, including without limitation the Employee Retirement Income Security Act of 1974 (ERISA), with respect to Client, any Plan, Plan Sponsor, Member or Enrollee.

  • Determine whether the Member or Enrollee referred to EOHHS meets the requirements to participate in the SKSC Program as set forth in Exhibit A to this Attachment 1.

  • HPS shall not supply information ------------------------------ regarding any Member or Enrollee to any party that is not affiliated with HPS or SunStar, except as may be required by this Agreement or Applicable Law, or as permitted by such Member or Enrollee.


More Definitions of Member or Enrollee

Member or Enrollee means a Medicaid-eligible person receiving benefits through a RIte Care managed care organization.
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Member or Enrollee means a Potential Member who has enrolled with Contractor.
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Member or Enrollee. - means any person enrolled in the prepaid program of the HMO who has selected the IPA as his/her provider of Medical Services.
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Related to Member or Enrollee

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Enrollee means any person entitled to health care services from a carrier.

  • Non-Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • 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.

  • Psychiatric nurse means a registered nurse who has

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • Non-Participating Clinical Professional Counselor means a Clinical Professional Counselor who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have 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 not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Health care practitioner means an individual licensed

  • Genetic counselor means a person licensed by the Board to engage in the practice of genetic

  • 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.

  • Registered Health Practitioner means a health practitioner registered, or licensed, as a health practitioner (or as a health practitioner of a particular type) under a law of a State or Territory that provides for the registration or licensing of health practitioners (or health practitioners of that type).

  • Certified nurse practitioner means an individual who is licensed as a registered professional nurse under part 172 who has been granted a specialty certification as a nurse practitioner by the Michigan board of nursing under section 17210.

  • Health care entity means any health care provider, health plan or health care clearinghouse.

  • Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

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

  • Managed health care system means: (a) Any health care

  • Community or broad-based enterprise means an enterprise that has an empowerment shareholder who represents a broad base of members such as a local community or where the benefits support a target group, for example black women, people living with disabilities, the youth and workers. Shares are held via direct equity, non-profit organisations and trusts.

  • Community health worker means an individual who:

  • Participating Clinical Professional Counselor means a Clinical Professional Counselor who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • psychiatric emergency medical condition means a Mental Disorder that manifests itself by acute symptoms of sufficient severity that it renders the patient as being either of the following:

  • 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).

  • Nurse practitioner means an advanced practice registered nurse who is jointly licensed by the

  • Psychiatric hospital means an Institution constituted, licensed, and operated as set forth in the laws that apply to Hospitals, which meets all of the following requirements:

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.