Benefit Design and Administration Clause Samples
The "Benefit Design and Administration" clause defines how employee benefits are structured and managed within an organization or under a specific agreement. It typically outlines the types of benefits offered, such as health insurance, retirement plans, or paid leave, and specifies the processes for enrolling, modifying, or terminating these benefits. This clause ensures that both parties understand the scope and administration of benefits, providing clarity and consistency in how benefits are delivered and managed.
Benefit Design and Administration. All terms of Article 6 apply to Medical Assistance, MinnesotaCare, and MinnesotaCare/Medical Assistance Enrollees, unless otherwise stated.
Benefit Design and Administration. All terms of Article 6 apply to MSHO and MSC+, unless otherwise stated. Medicare Services provided by the MCO must comply with the requirements of this Article.
Benefit Design and Administration. All terms of Article 6 apply unless otherwise stated. Medicare services provided by the MCO shall comply with the requirements of this Article.
Benefit Design and Administration. 115
6.1 SNBC Covered Services 115 Acupuncture Services 115 Advanced Practice Nurse Services 115 Early Intensive Developmental and Behavioral Intervention (EIDBI) Services 115 Cancer Clinical Trials 118 Care Management Systems 118 Case Management System 119 Substance Use Disorder Treatment Services 124 Child and Teen Checkups 125 Chiropractic Services 126 Clinic Services 126 Community Medical Response Emergency Medical Technician Services 126 Community Health Worker Services 126 Community Paramedic Services 127 Dental Services 127 Treatment of End Stage Renal Disease (ESRD) 129 Family Planning Services 129 Gender Confirmation Surgery 130 Health Homes 130 Specific Home Care Services 132 Hospice Services 134 Inpatient Hospital Services 135 Interpreter Services 135 Laboratory, Diagnostic and Radiological Services 135 Pre-Admission Screening (PAS) for SNBC 135 Medical Emergency, Post-Stabilization Care, and Urgent Care Services 137 Medical Equipment and Supplies 138 Medical Equipment, Assistive Technology 139 Medical Transportation Services 140 Non-emergency Transportation that is Not the Responsibility of the MCO 141 Mental Health Services 141 Nursing Facility (NF) Services 156 Obstetrics and Gynecological Services 156 Outpatient Hospital Services 157 Physician Services 157 Podiatric Services 157 Prescription Drugs and Over-the-Counter Drugs 157 Medication Therapy Management (MTM) Care Services 161 Prescribing, Electronic. 161 Prosthetic and Orthotic Devices 161 Public Health Services 161 Reconstructive Surgery 161 Rehabilitative and Therapeutic Services 161 Second Opinion. 161 Skilled Nursing Facility (SNF) Services 162 Specialty Care. 162 Telemedicine Services 163 Transplants 163 Tuberculosis Related Services 163 Vaccines and Immunizations 164 Vision Care Services 164
6.2 State-funded Covered Services 164
6.3 In Lieu of Services Permitted. 164 Authorized In Lieu of Services 164 6.4 Additional Services Permitted. 165 6.5 Special Education Services 165 6.6 Limitations on MCO Services 165 Medical Necessity 165 Coverage Limited to Program Coverage 166 6.7 Services Not Covered By This Contract 166 Abortion Services 166 Circumcision 166 Drugs covered under the Medicare Prescription Drug Program 166 Certain Mental Health Services 166 Developmental Disability Case Management 166 Essential Community Supports 166 HIV Case Management 166 Personal Care Assistant Services 166 Qualified Professional Supervision for PCA Services 166 Home Care Nursing 166 ICF/DD services, i...
Benefit Design and Administration. 103 6.1 SNBC Covered Services 103 6.1.1 Acupuncture Services 103 6.1.2 Advanced Practice Registered Nurse Services. 103
Benefit Design and Administration. All terms of Article 6 apply to MA, GAMC, MinnesotaCare and MinnesotaCare/MA Enrollees, unless otherwise stated.
Benefit Design and Administration