Beneficiary Protections referral requirements.
Beneficiary Protections. Medicare+Choice plans are required to meet a number of beneficiary protection requirements. They are required to disclose plan information to enrollees. They are required to have procedures relating to coverage decisions, reconsiderations, and appeals. Further, they are required to assure the confidentiality and accuracy of enrollee records. Marketing material used by Medicare+Choice plans must be approved by the Secretary.
Beneficiary Protections. The New Section 1860D-1 would establish guaranteed issue and community-rating requirements. The provision would specify that individuals electing qualified prescription drug coverage under a PDP plan or MA Rx or EFFS Rx plan could not be denied enrollment based on health status or other factors. MA provisions relating to priority enrollment (where capacity limits have been reached) and limitations on terminations of elections would apply to PDP sponsors. The provision would require PDP sponsors to make drug coverage available to all eligible individuals residing in the area without regard to their health or economic status or their place of residence in the area. The New Section 1860D-3 would specify required beneficiary protections. Plans would have to comply with guaranteed issue and community-rated premium requirements specified in the new Section 1860D-1, access to negotiated prices as specified in the new Section 1860D-2, and the non-discrimination provisions specified in the new Section 1860D-6. PDP plan sponsors would be required to disclose, to each enrolling beneficiary, information about the plan’s benefit structure. The plan would have to disclose information on:
Beneficiary Protections. Eligible entities offering Medicare Prescription Drug Plans would be required to disclose plan information comparable to that required for MedicareAdvantage plans. Entities would have to disclose information on access, operation of any formulary, beneficiary cost-sharing, and grievance and appeals procedures. Further, upon request of an individual, they would be required to disclose general information on coverage, utilization, and grievance procedures. An eligible entity would be required to have a mechanism for providing specific information to enrollees, upon request, including information on coverage of specific drugs and changes in its formulary. Entities would be required to provide easily understandable explanation of benefits and a notice of benefits in relation to the initial coverage limit and the annual out-of-pocket limit. The MedicareAdvantage requirements relating to approval of marketing materials would apply to information provided by entities on drug plans. The bill would include several provisions designed to assure beneficiary access to drugs. Eligible entities would be required to have in place procedures to ensure that beneficiaries were not charged more than the negotiated price of a covered drug. The procedures would include the issuance of a card or other technology that could be used by a beneficiary to assure access to negotiated prices for which coverage was not otherwise provided under the plan. Entities would be required to secure the participation in the network of a sufficient number of pharmacies that dispensed drugs directly to patients (other than by mail order) to ensure convenient access for beneficiaries. The Administrator would be required to establish standards to ensure convenient access, including emergency access. The standards would take into account reasonable distances to pharmacy services in both urban and rural areas and to pharmacy services and access to pharmacy services of the Indian health service and Indian tribes and tribal organizations. An entity would be required to establish a point-of-service method of operation under which the plan would provide access to any or all pharmacies not participating in the network and could charge beneficiaries, through adjustments in cost sharing, the additional costs associated with this option. This additional cost sharing would not count toward the program’s cost-sharing requirements or benefit limits. Entities would be required to permit enrollees receiving benefit...
Beneficiary Protections. New Section 1860D-4 establishes beneficiary protection requirements for qualified prescription drug plans. PDP plan sponsors are required to disclose, to each enrolling beneficiary, information about the plan’s benefit structure. The plan will disclose information on: 1) access to specific covered drugs (including access through pharmacy networks); 2) how any formulary (including a tiered formulary) used by the sponsor functions, including how a beneficiary might obtain information on the formulary; 3) copayment and deductible requirements (including any applicable tiered copayment requirements; and 4)
Beneficiary Protections. 3.1 This Guarantee is a continuing guarantee and shall remain in full force and effect until all Guaranteed Obligations have been paid in full.
Beneficiary Protections. 3.1 The Guarantor acknowledges and agrees that the provisions of this Guarantee are and at all times shall be a continuing security and shall continue in effect until all sums demanded and due at any time from the Service Provider to TTL under the Agreement have been finally paid in full, and all obligations of the Service Provider under the Agreement have been fully performed, notwithstanding any intermediate payment, partial settlement or partial performance or other matter,
Beneficiary Protections. 3.1 The Guarantor acknowledges and agrees that the provisions of this Guarantee are and at all times shall be a continuing security and shall extend to cover sums demanded and due at any time from the Service Provider to TfL under the Agreement.
Beneficiary Protections
