BENEFICIARY LIABILITY Clause Samples
The Beneficiary Liability clause defines the responsibilities and potential legal obligations of the beneficiary under an agreement. It typically outlines the circumstances under which the beneficiary may be held liable for losses, damages, or breaches related to the contract, such as misuse of funds or failure to comply with specified terms. This clause serves to clarify the extent of the beneficiary's accountability, thereby allocating risk and ensuring all parties understand the consequences of non-compliance or misconduct.
BENEFICIARY LIABILITY. A. The CONTRACTOR or an affiliate, vendor, contractor, or subcontractor of the CONTRACTOR shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this contract, except to collect other health insurance coverage, share of cost, and co-payments. (Cal. Code Regs., tit. 9, § 1810.365 (a).)
B. The CONTRACTOR or an affiliate, vendor, or sub-subcontractor of the CONTRACTOR shall not hold beneficiaries liable for debts in the event that the CONTRACTOR becomes insolvent; for costs of covered services for which the State or MHP does not pay the CONTRACTOR; for costs of covered services for which the State or the COUNTY does not pay the CONTRACTOR’S network providers; for costs of covered services provided under a contract, referral or other arrangement rather than from the CONTRACTOR; or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary. 42 C.F.R. § 438.106 and Cal. Code Regs. tit 9, § 1810.365(c).)
C. The CONTRACTOR shall ensure its providers and any subcontractors do not bill beneficiaries, for covered services, any amount greater than what is identified within the contract.
BENEFICIARY LIABILITY. The legal obliga- tion of a beneficiary, his or her estate, or responsible family member to pay for the costs of medical care or treat- ment received. Specifically, for the purposes of services and supplies cov- ered by CHAMPUS, beneficiary liabil- ity includes any annual deductible amount, cost-sharing amounts, or, when a provider does not submit a claim on a participating basis on be- half of the beneficiary, amounts above the CHAMPUS-determined allowable cost or charge. Beneficiary liability also includes any expenses for medical or related services and supplies not covered by CHAMPUS.
BENEFICIARY LIABILITY. 13.1. CONTRACTOR or an affiliate, vendor, contractor, or subcontractor of the Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this contract, except to collect other health insurance coverage, share of cost, and co-payments. (Cal. Code Regs., tit. 9, § 1810.365 (a).)
13.2. CONTRACTOR or an affiliate, vendor, contractor, or sub-subcontractor of the Contractor shall not hold beneficiaries liable for debts in the event that the Contractor becomes insolvent; for costs of covered services for which the State does not pay the Contractor; for costs of covered services for which the State or the Contractor does not pay the Contractor's network providers; for costs of covered services provided under a contract, referral or other arrangement rather than from the Contractor; or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary. 42 C.F.R. § 438.106 and Cal. Code Regs. tit 9, § 1810.365(c).)
13.3. CONTRACTOR shall ensure its subcontractors and providers do not bill beneficiaries, for covered services, any amount greater than would be owed if the Contractor provided the services directly (42 C.F.R. § 483.106(c).).
BENEFICIARY LIABILITY. CONTRACTOR or an affiliate, vendor, contractor, or subcontractor of the Contractor shall not submit a claim to, or demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this contract, except to collect other health insurance coverage, share of cost, and co-payments. (Cal. Code Regs., tit. 9, § 1810.365 (a).)
BENEFICIARY LIABILITY. Beneficiary shall:
(a) be liable to Trustee for all Losses and Liabilities Trustee sustain, pay or incur; and
(b) indemnify and save Trustee harmless against all Losses and Liabilities brought against or suffered by Trustee, its directors, officers, agents and employees or that Trustee, its directors, officers, agents and employees sustain, pay or incur; as a result of a breach by Beneficiary of an express term of this Agreement or the negligence of Beneficiary in the performance or non-performance of this Agreement.
BENEFICIARY LIABILITY. The legal obliga- tion of a beneficiary, his or her estate, or responsible family member to pay for the costs of medical care or treat- ment received. Specifically, for the purposes of services and supplies cov-