BENEFIT PROGRAM REQUIREMENTS Clause Samples
The "Benefit Program Requirements" clause defines the specific conditions and standards that must be met for participants to be eligible for and to maintain benefits under a particular program. This may include criteria such as minimum hours worked, length of employment, or compliance with company policies. For example, employees might need to enroll within a certain timeframe or provide documentation to receive health insurance or retirement benefits. The core function of this clause is to ensure clarity and consistency in the administration of benefit programs, helping both employers and employees understand the rules and avoid misunderstandings or disputes regarding eligibility.
BENEFIT PROGRAM REQUIREMENTS. PPG agrees:
1. That all Member Physicians will comply with the terms and conditions of this Addendum, the terms of the applicable Benefit Programs, and of the Operations Manual.
2. To comply with FHS efforts to provide Case Management. PPG agrees to provide PPG’s written treatment plan within five (5) working days of receipt of request from FHS. A treatment plan includes a statement of diagnosis, current patient condition, current or proposed treatment, and anticipated outcomes.
3. That if PPG admits or arranges for an inpatient admission to a non-Participating Provider or facility for an elective procedure, PPG shall document that PPG has given such Member prior notice of the following:
a) Provider or facility is non-participating;
b) The non-Participating Provider or facility will not be restricted to seeking payment only from FHS; and
c) The non-Participating provider or facility may ▇▇▇▇ the Member for amounts other than deductibles, Copayments, and medical services not covered under the Member’s Coverage Certificate.
4. That PPG may appeal a Utilization/Care Management decision as set forth in the Operations Manual.
5. FHS agrees that any determination under the Utilization/Care Management Program that a Member’s services rendered by PPG were not Medically Necessary shall not retroactively affect PPG’s right to payment hereunder if such services were authorized by FHS prior to admission and the information provided by PPG to FHS regarding the Member’s medical condition was substantially true and accurate.
BENEFIT PROGRAM REQUIREMENTS. PROVIDER agrees:
1. To comply with the terms and conditions of this Addendum, the terms of the applicable Benefit Programs, and of the Operations Manual.
2. To comply with HNI's efforts to provide Case Management. PROVIDER agrees to provide PROVIDER's written treatment plan within five (5) working days of receipt of request from HNI. A treatment plan includes a statement of diagnosis, current patient condition, current or proposed treatment, and anticipated outcomes.
BENEFIT PROGRAM REQUIREMENTS. The rules, procedures, policies, protocols and other conditions to be followed by RPO, RPO Providers and Participating Providers and Members with respect to providing Covered Medical Services under a particular Benefit Program.
BENEFIT PROGRAM REQUIREMENTS. The rules, procedures, ----------------------------- policies, protocols and other conditions to be followed by Participating Providers and Beneficiaries with respect to providing Covered Medical Services under a particular Benefit Program.
BENEFIT PROGRAM REQUIREMENTS. The rules, procedures, policies, protocols and other conditions to be followed by Participating Providers and Beneficiaries at the time Covered Services are rendered with respect to providing and receiving Covered Services under a particular Benefit Program as set forth in the Benefit Program documents.