DENTAL PLAN PROGRAM STANDARDS Clause Samples

The "Dental Plan Program Standards" clause establishes the minimum requirements and operational guidelines that a dental plan must meet to be considered compliant under the agreement. This typically includes specifications regarding covered services, provider qualifications, claims processing procedures, and quality assurance measures. By setting these standards, the clause ensures that all parties have a clear understanding of the expectations for dental plan administration, thereby promoting consistent service quality and protecting the interests of plan participants.
DENTAL PLAN PROGRAM STANDARDS. ‌ 2.1 GENERAL‌ This article describes the operational and financial standards with which Contractor must comply in full. The standards have been set to allow plans flexibility in their approach to meeting program objectives, while ensuring that the special needs of these populations are addressed. EOHHS and the Contractor will work collaboratively to build a successful program that will achieve the stated goals and requirements of EOHHS. EOHHS and the Contractor will engage in a planning period initiating at the start of this contract to address opportunities for program improvements. EOHHS agrees to purchase, and Contractor agrees to fulfill all requirements and to furnish or arrange for the delivery of, the scope of services as specified in this Article. In return for Capitation Payments (as defined in Sections 1.9 and 2.15 of this Agreement), the Contractor agrees to provide eligible members with the dental care and services described in this Article II and Attachment A hereto. Contractor shall furnish or arrange for the personnel, facilities, equipment, supplies, pharmaceuticals, and other items and expertise necessary for, or incidental to, the provision of dental care services specified below, at locations including, but not limited to, the entire State of Rhode Island, to Members covered by this agreement and enrolled with Contractor. In accordance with 42 CFR § 438.6, Contractor will provide or arrange for the provision of Covered Services under this Risk Contract. Contractor’s legal responsibility to EOHHS is to assure that all activities specified in this contract are carried out and will not be altered if a service is arranged by Contractor or provided by a subcontractor. 2.2 LICENSURE/CERTIFICATION‌ The Contractor certifies that it is licensed in Rhode Island as an HMO under the provisions of Chapter 27-41, “the HMO Act” or that it will become licensed as a Health Maintenance Organization (HMO) or Health/dental plan (HP) in the State of Rhode Island by the Rhode Island Department of Business Regulation prior to signing an Agreement with EOHHS. If Contractor is not a licensed HMO in Rhode Island, the Contractor certifies that it is either a nonprofit hospital service corporation that is licensed by the Rhode Island Department of Business Regulation (DBR) under Chapter 27-19 of the Rhode Island General Laws, a nonprofit medical service corporation that is licensed by DBR under Chapter 27-20 of the Rhode Island General Laws, or another health insura...
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DENTAL PLAN PROGRAM STANDARDS. 3. Section 2.13 (B)(ii), Encounter Data Reporting- General Requirements, is amended by INSERTING the following paragraph after the first paragraph of this section: “The Contractor will comply with the requirements of Section 6507 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), regarding “Mandatory State Use of National Correct Coding Initiatives,” including all applicable rules, regulations, and methodologies, as amended or modified, in accordance with EOHHS policy.”
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DENTAL PLAN PROGRAM STANDARDS. 1. Section 2.5.B Dental Plan Enrollment Procedures is amended by DELETING paragraph 3 and REPLACING it with the following: “Contractor agrees to enroll, in the order in which he or she applies or is assigned, any eligible beneficiary who selects it or is assigned to it, regardless of the beneficiary’s race, color, national origin, sex, sexual orientation, disability, age, ethnicity, language needs, health status, or need for health services.” 2. Section 2.5.B Dental Plan Enrollment Procedures is amended by DELETING paragraph 6 and REPLACING it with the following: “The Contractor shall not use any policy or practice that has the effect of discriminating against individuals eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, or disability.” 3. This Attachment is amended by DELETING the Attachment in its entirety and REPLACING it with a new ATTACHMENT E dated April 25, 2025 and the Attachment is now titled “ATTACHMENT E: CONTRACTOR’S MONTHLY CAPITATION RATES SFY 2026.” 4. This Section is further amended by ADDING the SFY 2026 Capitation Rate Development and Rate Change Summary table, to ATTACHMENT E, see Exhibit A. 5. This Attachment is amended by DELETING the Attachment in its entirety and REPLACING it with a new Attachment F dated April 25, 2025.
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DENTAL PLAN PROGRAM STANDARDS 
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  • Educational Program A. DSST PUBLIC SCHOOLS shall implement and maintain the following characteristics of its educational program in addition to those identified in the Network Contract at DSST ▇▇▇▇ MIDDLE SCHOOL (“the School” within Exhibit A-3). These characteristics are subject to modification with the District’s written approval:

  • Meal Plan 18. Residents are required to purchase a meal plan for both semesters. Refer to ▇▇▇.▇▇▇▇▇▇▇▇.▇▇/▇▇▇▇ for details on meal plan rates. Residents may contract for a meal plan of a higher value than stipulated in the fee schedule. 19. The meal plan may only be used to purchase food and beverages at Food Service outlets designated by the University. Meal plans cannot be used to purchase alcohol or gift certificates from any of our Off Campus Partners or to pay any other fees owed to the University of Windsor. 20. Selling of unused meal plan money is not permitted. 21. The University accepts no liability for lost, misplaced or stolen student cards and reserves the right to confiscate without recourse, any student card which bears evidence of alterations. 22. Any unused balance remaining in the meal plan accounts of the Resident on the termination date of this Agreement, will be subject to the University of Windsor Meal Plan Carry-Forward Policy. 23. Residents may add money to their meal plan at the Food Services office, J01 in Vanier Hall or the UwinCard Office in the CAW Student Centre (lower level). 24. The meal plan account is HST exempt on most purchases made at Food Service outlets on campus, except on taxable items at the Bru in Alumni Hall or with our Off Campus Partners. This is a current meal plan tax policy and is subject to change in accordance with provincial or federal legislation. 25. Meal plan fees or hours of operation are subject to change as deemed necessary or when due to circumstances beyond Food Services' control. The University reserves the right to increase or otherwise change the prices of items available for purchase in its Food Service outlets. Residents will be given reasonable notice of changes to the plan and such changes will be made fairly and in due consultation with student representatives.

  • Leave Donation Program Employees may donate paid leave to a fellow employee who is otherwise eligible to accrue and use sick leave and is employed by the same Agency. The intent of the leave donation program is to allow employees to voluntarily provide assistance to their co-workers who are in critical need of leave due to the serious illness or injury of the employee or a member of the employee's immediate family. The definition of immediate family as provided in rule 123:1-47-01 of the Administrative Code shall apply for the leave donation program. A. An employee may receive donated leave, up to the number of hours the employee is scheduled to work each pay period, if the employee who is to receive donated leave: 1. Or a member of the employee's immediate family has a serious illness or injury; 2. Has no accrued leave or has not been approved to receive other state-paid benefits; and 3. Has applied for any paid leave, workers' compensation, or benefits program for which the employee is eligible. Employees who have applied for these programs may use donated leave to satisfy the waiting period for such benefits where applicable, and donated leave may be used following a waiting period, if one exists, in an amount equal to the benefit provided by the program, i.e. fifty six hours (56) pay period may be utilized by an employee who has satisfied the disability waiting period and is pending approval, this is equal to the seventy percent (70%) benefit provided by disability. B. Employees may donate leave if the donating employee: 1. Voluntarily elects to donate leave and does so with the understanding that donated leave will not be returned; 2. Donates a minimum of eight hours; and 3. Retains a combined leave balance of at least eighty hours. Leave shall be donated in the same manner in which it would otherwise be used except that compensatory time is not eligible for donation. C. The leave donation program shall be administered on a pay period by pay period basis. Employees using donated leave shall be considered in active pay status and shall accrue leave and be entitled to any benefits to which they would otherwise be entitled. Leave accrued by an employee while using donated leave shall be used, if necessary, in the following pay period before additional donated leave may be received. Donated leave shall not count toward the probationary period of an employee who receives donated leave during his or her probationary period. Donated leave shall be considered sick leave, but shall never be converted into a cash benefit. D. Employees who wish to donate leave shall certify: 1. The name of the employee for whom the donated leave is intended; 2. The type of leave and number of hours to be donated; 3. That the employee will have a minimum combined leave balance of at least eighty hours; and 4. That the leave is donated voluntarily and the employee understands that the donated leave will not be returned. E. Appointing authorities shall ensure that no employees are forced to donate leave. Appointing authorities shall respect an employee's right to privacy, however appointing authorities may, with the permission of the employee who is in need of leave or a member of the employee's immediate family, inform employees of their co-worker's critical need for leave. Appointing authorities shall not directly solicit leave donations from employees. The donation of leave shall occur on a strictly voluntary basis.

  • Dental Plan (a) The Employer shall pay the monthly premium for employees entitled to coverage under a mutually acceptable plan which provides: (1) Part A, 100% coverage; (2) Part B, 65% coverage (3) Part C, 55% coverage. (b) Orthodontic services are subject to a lifetime maximum payment of $3,500 per patient.

  • 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.