Benefit Coordination Clause Samples
The Benefit Coordination clause establishes how benefits are managed when an individual is covered by more than one insurance policy or benefit plan. It typically outlines the order in which each plan pays, ensuring that the combined payments do not exceed the total cost of the covered services. This clause prevents duplication of payments and clarifies the responsibilities of each insurer, ultimately ensuring that claims are processed efficiently and fairly without overcompensation.
Benefit Coordination. The function of coordinating benefit payments from other payers, for services delivered to an Enrollee, when such Enrollee is covered by another coverage source.
Benefit Coordination. An eligible employee who files an LTD claim and concurrently takes a leave of absence without pay will be required to use accruals as provided in Section B herein during the eighteen (18) week entitlement period of a medical leave specified in Section 10.4 -
Benefit Coordination. It is agreed the Company will provide an additional 6 months maximum (month of layoff + 5 additional months) of benefit coverage per Article 20 (Life, Major Medical, Drug, and Dental only) of the Collective Bargaining Agreement.
Benefit Coordination the function of coordinating benefit payments from other payers, for services delivered to an Enrollee, when such Enrollee is covered by another insurer. Board of Hearings (BOH) – the Board of Hearings within the Executive Office of Health and Human Services’ Office of Medicaid. BOH Appeal – a written request to the BOH, made by an Enrollee or Appeal Representative to review the correctness of a Final Internal Appeal decision by the Contractor. Bureau of Special Investigations (BSI) – a bureau within the Office of the State Auditor that is charged with the responsibility of investigating Member fraud within the Commonwealth’s public assistance programs, principally those administered by the Department of Transitional Assistance (DTA), the EOHHS Office of Medicaid and the Department of Children and Families (DCF). Business Associate – a person, organization or entity meeting the definition of a “business associate” for purposes of the Privacy and Security Rules (45 CFR §160.103). CANS IT System – a web-based application accessible through the EOHHS Virtual Gateway into which Behavioral Health Providers serving Members under the age of 21 will input: (1) the information gathered using the CANS Tool; and (2) the determination whether the assessed Member has a Serious Emotional Disturbance. Care Coordinator – a provider-based clinician or other trained individual who is employed or contracted by the Contractor or an Enrollee’s PCP. The Care Coordinator is accountable for providing care coordination activities, which include assuring appropriate referrals and timely two-way transmission of useful patient information; obtaining reliable and timely information about services other than those provided by the PCP; participating in the Enrollee’s Comprehensive Assessment, if any; and supporting safe transitions in care for Enrollees moving between settings in accordance with the Contractor’s Transitional Care Management program. The Care Coordinator may serve on one or more care teams, coordinates and facilitates meetings and other activities of those care teams.
Benefit Coordination. With respect to the payment for fringe benefits, job sharing terms and conditions of employment specified in Section C, 3 shall take precedence over Article XXXIV, Section B.
Benefit Coordination. For those employees who retire on or after February 25, 2000, any payments under the pension plan shall be coordinated pursuant to MCL 418.354 of the Workers’ Disability Compensation Act, except that an employee who is receiving a duty disability benefit and has not reached age 50 shall have any Workers’ Compensation benefit coordinated so that the combination of retirement benefit and Workers’ Compensation benefit is equal to 100% of the employee’s net (take home) salary or wage at the time of retirement.