Capitated Health Plans Sample Clauses

Capitated Health Plans. Section V, Covered Services, Item H., Coverage Provisions, sub-item 10., Hospital Services – Inpatient The Health Plan may provide services in a nursing home as downward substitution for inpatient services. Such services shall not be counted as inpatient hospital days. Non-Reform Health Plans not covering transportation as an optional service Section V, Covered Services, Item H., Coverage Provisions, sub-item 20., Transportation Services The Health Plan shall refer enrollees needing transportation to the Agency’s contracted Commission for the Transportation Disadvantaged (CTD) provider in order to assist them to keep and travel to medical appointments. Non-Reform HMOs covering transportation as an optional service and Reform Health Plans Section V, Covered Services, Item H., Coverage Provisions, sub-item 20., Transportation Services The Health Plan shall provide transportation services, including emergency transportation, for its enrollees who have no other means of transportation available to any Medicaid-compensable, medically necessary service, including Medicaid services not covered by this Contract such as prescribed pediatric extended care (this example does not apply to the specialty plan for children with chronic conditions).
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Capitated Health Plans. Section V, Covered Services, Item H., Coverage Provisions, sub-item 10., Hospital Services – Inpatient The Health Plan may provide services in a nursing home as downward substitution for inpatient services. Such services shall not be counted as inpatient hospital days.
Sample 1Sample 2

Related to Capitated Health Plans

  • Extended Health Plan (a) The Employer will pay 100% of the monthly premiums for the extended health care plan that will cover the employee, their spouse and dependent children, provided they are not enrolled in another plan.

  • Health Plans The health plans offered and benefits provided by those plans shall be those approved by the City's JLMBC and administered by the Personnel Department in accordance with LAAC Section 4.

  • Health Plan An appropriately licensed entity that has entered into a contract with Subcontractor, either directly or indirectly, under which Subcontractor provides certain administrative services for Health Plan pursuant to the State Contract. For purposes of this Appendix, Health Plan refers to UnitedHealthcare Insurance Company.

  • Requiring Health Benefits for Covered Employees Contractor agrees to comply fully with and be bound by all of the provisions of the Health Care Accountability Ordinance (HCAO), as set forth in San Francisco Administrative Code Chapter 12Q, including the remedies provided, and implementing regulations, as the same may be amended from time to time. The provisions of section 12Q.5.1 of Chapter 12Q are incorporated by reference and made a part of this Agreement as though fully set forth herein. The text of the HCAO is available on the web at xxx.xxxxx.xxx/xxxx. Capitalized terms used in this Section and not defined in this Agreement shall have the meanings assigned to such terms in Chapter 12Q.

  • Medical Plans The Employer will maintain the current health (including vision) and dental insurance programs and practices. The Employer shall contribute 80% of the premium charge for PPO plans, 83% of premium for the POS plan, 85% of premium for the HMO plan, 80% for the prescription drug plan and 50% for the dental plan. There shall be no change in the State’s premium subsidy for health benefits plans in Fiscal Year 2012.

  • Extended Health Benefits The extended health benefits coverage for CUPE and Fire will be amended to include:

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Extended Health Care Benefits 12.02(a) The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended. Eligible Expenses (Benefit year January 1 – December 31)

  • Medical Plan ‌ Eligible employees and dependants shall be covered by the British Columbia Medical Services Plan or carrier approved by the British Columbia Medical Services Commission. The Employer shall pay one hundred percent (100%) of the premium. An eligible employee who wishes to have coverage for other than dependants may do so provided the Medical Plan is agreeable and the extra premium is paid by the employee through payroll deduction. Membership shall be a condition of employment for eligible employees who shall be enrolled for coverage following the completion of three (3) months’ employment or upon the initial date of employment for those employees with portable service as outlined in Article 14.12.

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