Targeted Enrollee definition

Targeted Enrollee means a Medicare beneficiary who is enrolled in one of the Part D Sponsor’s Model PBPs and who is targeted by the Part D Sponsor to receive rewards and incentives in the Part D Sponsor’s RI program based on the Approved Proposal.
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Targeted Enrollee means a Medicare beneficiary who is enrolled in one of the MAO’s VBID PBPs participating in the Model and targeted by the MAO to receive interventions as permitted under one or more VBID Components. The standards and criteria used by the MAO to identify Targeted Enrollees may vary depending on the VBID Component and must be identified in the Approved Proposal and approved by CMS. Per the Addendum, “Additional Benefits” means extra MA and Part D benefits (in addition to MA and, as applicable, Part D benefits required to be offered by the terms of the Underlying Agreement (including basic benefits, standard prescription drug coverage, and supplemental benefits)) offered by the MAO under the Model and may be in the form of additional items and services and reductions in cost sharing. Additional Benefits includes reductions in Part D cost sharing targeted to LIS beneficiaries, which are referred to as “Part D Cost Sharing Reductions Based on SES.”
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Targeted Enrollee means a Medicare beneficiary who is enrolled in one of the MAO’s VBID PBPs participating in the Model and targeted by the MAO to receive one or more VBID Components, except for the Cash or Monetary Rebates Component, WHP, and the Hospice Benefit Component. All enrollees in the VBID PBP participating in the Cash or Monetary Rebates Component and the Hospice Benefit Component are eligible for those Model Benefits but the participating MAO may also target enrollees for specific supplemental hospice benefits (Targeted Hospice Enrollees).
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Examples of Targeted Enrollee in a sentence

  • Receipt by the Targeted Enrollee of preventative health services, such as receiving Part D covered vaccines.

  • Receipt by the Targeted Enrollee with Pre-Diabetes or Diabetes of preventative health services, such as receiving Part D covered vaccines.

  • These terms include, but are not limited to, the following: Approved Proposal, Cash or Monetary Rebates, Cash or Monetary Rebates Component, MA Organization, Plan Year, Rewards and Incentives Program, Targeted Enrollee, and VBID PBP.

  • These terms include, but are not limited to, the following: Targeted Enrollee, Part D Sponsor, and Part D RI Program.

  • These terms include, but are not limited to, the following: Approved Proposal, Diabetes, Part D RI Program, Part D Sponsor, Pre- diabetes, and Targeted Enrollee.

  • These terms include, but are not limited to, the following: Targeted Enrollee, MA Organization, and Rewards and Incentives Program.

  • The Part D Sponsor shall not conduct a Part D RI Program in a Model PBP that conditions eligibility for a reward or incentive on the Targeted Enrollee completing the same healthcare activity (or service) that the enrollee must complete for a reward or incentive to be available to that enrollee under the MA-VBID Model.

  • Part D Sponsor shall not conduct a Part D RI Program in a Model PBP that conditions eligibility for a reward or incentive on the Targeted Enrollee completing the same healthcare activity (or service) that the enrollee must complete for a reward or incentive to be available to that enrollee under the MA-VBID Model.


More Definitions of Targeted Enrollee

Targeted Enrollee means a Medicare beneficiary who is enrolled in one of the participating MAO’s VBID participating PBPs and targeted to receive one or more VBID Components, except for WHP and the Hospice Benefit Component. While all enrollees in VBID PBPs participating in the Hospice Benefit Component are eligible for those Model Benefits, a participating MAO may also target enrollees for specific supplemental hospice benefits (Targeted Hospice Enrollees).
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Related to Targeted 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.

  • HSP’s Personnel and Volunteers means the Controlling Shareholders (if any), directors, officers, employees, agents, volunteers and other representatives of the HSP. In addition to the foregoing, HSP’s Personnel and Volunteers shall include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives;

  • 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).

  • Subcontractor employee, as used in this clause, means any officer, partner, employee, or agent of a subcontractor.

  • New employee orientation means the onboarding process of a newly hired public employee, whether in person, online, or through other means or mediums, in which employees are advised of their employment status, rights, benefits, duties and responsibilities, or any other employment-related matters.

  • Contractor employee means prime Contractor and subcontractor employees who require agency access to perform work under a CMS contract.

  • Substance use disorder professional means a person

  • Non-Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist 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.

  • Target Population means persons with low incomes who have one or more disabilities, including mental illness, HIV or AIDS, substance abuse, or other chronic health condition, or individuals eligible for services provided pursuant to the Lanterman Developmental Disabilities Services Act (Division 4.5 (commencing with Section 4500) of the Welfare and Institutions Code) and may include, among other populations, adults, emancipated minors, families with children, elderly persons, young adults aging out of the foster care system, individuals exiting from institutional settings, veterans, and homeless people.

  • Newborn means a baby less than nine days old.

  • Non-Participating Clinical Social Worker means a Clinical Social Worker 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.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • Population means the population as ascertained at the last preceding census of which the relevant figures have been published;

  • Designated caregiver means a person who:

  • Service Planning Team or “SPT” means a team who includes the Individual and/or the Individual’s identified support network, Contractor’s lead administrative staff supporting medical, behavioral and activity oversight called out in this Contract, Contractor’s Administrator or designee and ODHS Designee. The team is responsible for overseeing the Individual’s Service Plan and all other associated plans or services in this Contract.

  • MCO means an organization having a certificate of authority or certificate of registration from the 11 Washington State Office of Insurance Commissioner that contracts with HCA under a comprehensive 12 risk contract to provide prepaid health care services to eligible HCA Enrollees under HCA managed 13 care programs.

  • PCP means Primary Care Provider.

  • Prime Contractor employee, as used in this clause, means any officer, partner, employee, or agent of a prime Contractor.

  • Primary care physician means a physician qualified to be an attending physician according to ORS 656.005(12)(b)(A) and who is a general practitioner, family practitioner, or internal medicine practitioner.

  • Continuing education hour or “CE Hour” means based on sixty clock minutes, and includes at least fifty minutes of participation in a group or self-study learning activity that meets the criteria of the NERC Continuing Education Program.

  • Adult abuse means the willful infliction of physical pain, injury or mental anguish or unreasonable

  • Cultural Competence or "culturally competent" means the ability to recognize and respond to health-related beliefs and cultur- al values, disease incidence and prevalence, and treatment efficacy. Examples of culturally competent care include striving to overcome cultural, language, and communications barriers, providing an environ- ment in which individuals from diverse cultural backgrounds feel com- fortable discussing their cultural health beliefs and practices in the context of negotiating treatment options, encouraging individuals to express their spiritual beliefs and cultural practices, and being fa- miliar with and respectful of various traditional healing systems and beliefs and, where appropriate, integrating these approaches into treatment plans.

  • Mobile crisis outreach team means a crisis intervention service for minors or families of minors experiencing behavioral health or psychiatric emergencies.

  • Public safety employee means a public employee who is employed as one of the following:

  • HMO a health maintenance organization doing business as such (or required to qualify or to be licensed as such) under HMO Regulations.