Benefit Management Clause Samples

Benefit Management. 4.5.1 Formulary, Plan Design, and Utilization Management 1. The State reserves the right to exclude medications on the Contractor’s formulary that are considered low-value medications (e.g., Duexis) and/or prefer medications with a lower net cost. 2. Contractor's financial bid shall include all clinical and utilization management programs such as step therapy, prior authorization, quantity limits, etc., as provided in the Solicitation. 3. Contractor shall manage prior authorization requests using State-approved criteria. 4. Contractor shall respond to prior authorization requests within forty-eight (48) hours, seven (7) days a week. 5. Contractor shall only initiate therapeutic interchanges when switching to drugs with a lower net cost (including rebates). 6. Contractor shall only initiate therapeutic interchanges on drug pairs authorized by the State. 7. Contractor shall provide the opportunity for the State to participate in patient assistance management or coordination programs. 8. Contractor shall provide a means of tracking claims using manufacturers’ or other entities’ patient assistance programs or coupons. 9. Contractor shall provide a system that adjusts Member accumulators when Members use patient assistance, coupons, or other similar manufacturer Member financial assistance programs. 10. Contractor shall not charge the State for any patient assistance, coupon, or other similar manufacturer co-pay assistance programs. 11. Contractor shall hold all negative formulary tier changes until 1/1 of the next Calendar year, unless directed otherwise by the State. 12. Contractor shall notify the State at least 90 calendar days prior to any formulary change. 13. Prior to making any modification to the formulary, Contractor shall advise the State regarding the impact on Members and whether it will impact any Rebate guarantees. 14. Contractor shall grandfather any formulary excluded drugs for up to three (3) months without any impact on financial guarantees during the initial plan year (i.e., discount and Rebate guarantees will be in effect as of the go-live date). 4.5.2 Specialty, LDD, New-to-Market 1. Contractor agrees that if a Specialty Drug package is lost, stolen, or not delivered, Contractor will not charge the Member or Plan Sponsor for such Specialty Drug. 2. Contractor agrees that Non-Specialty Drugs filled through a Specialty Pharmacy will be adjudicated and billed at Mail Order rates, and further, included with the Mail Order Network Discount guar...
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Related to Benefit Management

  • Financial Services Compensation Scheme 19.1 We are covered by the Financial Services Compensation Scheme (FSCS). Under the scheme, if we cannot meet our financial obligations to customers, you may be entitled to compensation. 19.2 The FSCS only protects certain types of customers, and there are maximum limits on the amount of compensation that can be claimed. There is more information on this in our FSCS Information Sheet and Exclusions List, which is available on our website (you can also get a copy from customer services) or at ▇▇▇.▇▇▇▇.▇▇▇.▇▇.

  • Termination Compensation Termination Compensation equal to two (2) times the Executive's Base Period Income shall be paid to the Executive in a single sum payment in cash on the thirtieth (30th) business day after the later of (a) the Control Change Date and (b) the date of the Executive's employment termination; provided that if at the time of the Executive's termination of employment the Executive is a Specified Employee, then payment of the Termination Compensation to the Executive shall be made on the first day of the seventh (7th) month following the Executive's employment termination.

  • Incentive, Savings and Retirement Plans During the Employment Period, the Executive shall be entitled to participate in all incentive, savings and retirement plans, practices, policies and programs applicable generally to other peer executives of the Company and its affiliated companies, but in no event shall such plans, practices, policies and programs provide the Executive with incentive opportunities (measured with respect to both regular and special incentive opportunities, to the extent, if any, that such distinction is applicable), savings opportunities and retirement benefit opportunities, in each case, less favorable, in the aggregate, than the most favorable of those provided by the Company and its affiliated companies for the Executive under such plans, practices, policies and programs as in effect at any time during the 120-day period immediately preceding the Effective Date or if more favorable to the Executive, those provided generally at any time after the Effective Date to other peer executives of the Company and its affiliated companies.

  • Health Care Savings Plan As provided in this Agreement, eligible ASF Members will participate in the health care savings plan (HCSP) established under Minnesota Statute 352.98, and as administered by the Plan Administrator. The Employer is responsible only for transferring funds, as specified in this agreement, to the Plan Administrator. Subd. 1. All ASF Members who receive severance pay as defined in Section A of this article must participate in the health care savings plan. Subd. 2. All severance pay as defined in Section B of this article shall be transferred to the severed employee's health care savings plan account. At the time of separation, if an ASF Member has an approved exception to participation in the health care savings plan account from the plan administrator, then the ASF Member shall receive this payment in one lump sum payment of cash.

  • EMPLOYEE-MANAGEMENT ADVISORY COMMITTEE 10.01 The Parties to this Collective Agreement agree to establish Employee-Management Advisory Committee(s) (EMAC) within the sites. Each Committee will consist of a maximum of six (6) persons with equal representation from the Parties. 10.02 In a site that has an established mechanism(s) that performs the functions of the EMAC as described in Clause 10.08 and where the mechanism(s) provides for the representation from this bargaining unit then the Employer and the Union Representative may mutually agree to waive Clause 10.01. 10.03 The representatives of the Employer on EMAC shall be those persons or alternates employed and designated by the Employer from time-to-time. 10.04 The representatives of the Union on EMAC shall be those Employees or Employee alternates designated by the Local from time-to-time. 10.05 The Parties mutually agree that the representatives of the Employer and the Union on EMAC should be the persons in authority whose membership should be as constant as reasonably possible with a minimum of alteration or substitution. 10.06 The Chair on EMAC shall be the senior representative of the Employer, and the Vice-Chair shall be the senior representative of the Union. 10.07 EMAC shall meet at a mutually acceptable hour and date. Either the Chair or the Vice-Chair may mutually call a special meeting to deal with urgent matters. 10.08 It is the function of EMAC to consider matters of mutual concern affecting the relationship of the Employer to its Employees and to advise and make recommendations to the Employer and the Union with a view to resolving difficulties and promoting harmonious relations between the Employer and its Employees. Zone matters of mutual concern may be referred to the Joint Task Force. 10.09 Either the Employer or the Union may have experts or advisors present at meetings of EMAC to make submissions to or to assist EMAC in the consideration of any specific problem. Each Party shall give the other reasonable advance notice of the anticipated presence of such experts or advisors. 10.10 Where an EMAC has not been established within a site, the Union may request a meeting with the designated Human Resources Department to discuss the formation of EMAC(s). 10.11 Within thirty (30) days of the request, the Parties will meet to discuss membership and subsequent development of Terms of Reference in accordance with Article 10: Employee Management Advisory Committee. (a) Every effort will be made by the Parties to schedule this Committee meeting during an appointed Employee’s regular working hours; and (b) In continuous operations, when (i) an Employee is not scheduled to work; and (ii) it is not possible to schedule the meetings during a time when the Employee is scheduled to work; and (iii) no alternate attendee is available or appropriate to attend, an Employee who attends a EMAC meeting shall be paid at the basic hourly rate of pay. 10.13 Time spent in meetings of this Committee (inclusive of travel time) during an Employee’s scheduled working hours shall be considered time worked and the Basic Rate of Pay will be paid to such Employees. 10.14 Where applicable, an Employee shall be entitled to claim travel time expenses in accordance with Article 38: Transportation and Subsistence.