Duration of Continued or Reinstated Benefits Sample Clauses

Duration of Continued or Reinstated Benefits. If, at the member's request, the Contractor continues or reinstates the member's benefits while the appeal is pending, the benefits must be continued until one of following occurs:
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Duration of Continued or Reinstated Benefits. If, at the Medicaid Managed Care Member's request, the CONTRACTOR continues or reinstates the Medicaid Managed Care Member's Benefits while the Appeal or state fair hearing is pending, the Benefits must be continued until one of following occurs: The Medicaid Managed Care Member withdraws the Appeal or state fair hearing. The Medicaid Managed Care Member fails to request a state fair hearing and continuation of Benefits within ten (10) Calendar Days after the CONTRACTOR sends the notice of an adverse resolution to the Enrollee’s Appeal under §438.408(d)(2) A state fair hearing officer issues a hearing decision adverse to the Medicaid Managed Care Member. Medicaid Managed Care Member Responsibility for Services Furnished While the Appeal is Pending If the final resolution of the Appeal is adverse to the Medicaid Managed Care Member (i.e., the CONTRACTOR's Adverse Benefit Determination is upheld), the CONTRACTOR may recover the cost of the services furnished to the Medicaid Managed Care Member while the Appeal was pending, to the extent that the services were furnished solely because of the requirements of this Section and in accordance with the requirements set forth in 42 CFR § 431.230(b) as specified in 42 CFR § 438.420(d). The CONTRACTOR may not submit any Encounter information related to the services Appeal if it recoups the money from the Medicaid Managed Care Member. Grievance System Information to Providers and Subcontractors The CONTRACTOR must provide the information specified at 42 CFR § 438.10(g)(2)(xi) in a state approved description about the Grievance System to all Providers and Subcontractor’s at the time they enter into a contract with the CONTRACTOR as follows: The Enrollee’s right to file a Grievance and/or Appeal, the requirements for filing, and timeframe for filing, Availability of assistance with filing Grievances and Appeals, The toll-free number to file oral Grievances and Appeals, The Enrollee’s right to request continuation of Benefits during an Appeal or state fair hearing filing, although the Enrollee may be liable for the cost of any continued Benefits if the Adverse Benefit Determination is upheld, and Any state-determined Provider's Appeal rights to challenge the failure of the organization to cover a service. Effectuation of Reversed Appeal Resolutions Services Not Furnished While Appeal is Pending: If the CONTRACTOR or the State fair hearing officer reverses a decision to deny, limit, or delay services that were not furnishe...
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Duration of Continued or Reinstated Benefits. If the CONTRACTOR continues or reinstates the enrollee's benefits while the appeal is pending, the benefits shall be continued until one of following occurs: • the enrollee withdraws the appeal; • the enrollee does not request a fair hearing within 10 days from when he CONTRACTOR mails an adverse CONTRACTOR decision; • the ADMINISTRATION's fair hearing decision adverse to the enrollee is made; or • the authorization expires or authorization service limits are met.
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Duration of Continued or Reinstated Benefits. If the TPA/HCO continues or reinstates the enrollee’s benefits while the appeal is pending, the benefits shall be continued until one of following occurs: • When the enrollee withdraws the appeal; • When the enrollee does not request a hearing within 10 days of receiving an adverse decision; • When the ADMINISTRATION hearing decision is adverse to the enrollee. • When the authorization expires or authorization service limits are met.
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Duration of Continued or Reinstated Benefits. The Contractor shall continue the enrollee’s benefits while the appeal is pending.
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Duration of Continued or Reinstated Benefits. If, at the Medicaid MCO Member's request, the Contractor continues or reinstates the Medicaid MCO Member's benefits while the Appeal is pending, the benefits must be continued until one of following occurs:
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Duration of Continued or Reinstated Benefits. If, at the Enrollee’s request, the Health Plan continues or reinstates the Enrollee’s benefits while the Appeal is pending, the benefits must be continued until one (1) of the following occurs:
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Related to Duration of Continued or Reinstated Benefits

  • Continued Benefits For a twenty-four (24) month ------------------ period (or, if less, the number of months from the Date of Termination until the Executive would have reached age sixty-five (65)) after the Date of Termination (the "Benefits Period"), the Company shall provide the Executive with group term life insurance, health insurance and long-term disability insurance benefits ("Welfare Benefits") substantially similar in all respects to those which the Executive is receiving immediately prior to the Notice of Termination (without giving effect to any reduction in such benefits subsequent to a Change in Control which reduction constitutes or may constitute Good Reason). Benefits otherwise receivable by the Executive pursuant to this Section 2.6(B)(ii) shall be reduced to the extent substantially similar benefits are actually received by or made available to the Executive by any other employer during the same time period for which such benefits would be provided pursuant to this Section 2.6(B)(ii) at a cost to the Executive that is commensurate with the cost incurred by the Executive immediately prior to the Executive's Date of Termination (without giving effect to any increased costs paid by the Executive after the Change in Control which constituted or might have constituted Good Reason); provided, however, that if the Executive becomes employed by a new employer which maintains a medical plan that either (i) does not cover the Executive or a family member or dependent with respect to a preexisting condition which was covered under the applicable Company medical plan, or (ii) does not cover the Executive or a family member or dependent for a designated waiting period, the Executive's coverage under the applicable Company medical plan shall continue (but shall be limited in the event of noncoverage due to a preexisting condition, to such preexisting condition) until the earlier of the end of the applicable period of noncoverage under the new employer's plan or the end of the Benefits Period. The Executive agrees to report to the Company any coverage and benefits actually received by the Executive from such other employer(s). The Executive shall be entitled to elect to change his level of coverage and/or his choice of coverage options (such as the Executive only or family medical coverage) with respect to the Welfare Benefits to be provided by the Company to the Executive to the same extent that actively employed senior executives of the Company are permitted to make such changes; provided, however, that in the event of any such changes the Executive shall pay the amount of any cost increase that would actually be paid by an actively employed executive of the Company by reason of making the same change in his level of coverage or coverage options.

  • NO EXPECTATION OF CONTINUED EMPLOYMENT BEYOND TERM OF CONTRACT Neither this contract nor any Board Policy, rule or evaluation procedure shall confer upon the Employee continued employment beyond the term provided in this contract.

  • Death, Disability or Retirement Subject to the provisions of Section 1 hereof, this Agreement shall terminate automatically upon the Executive's death, termination due to "Disability" (as defined below) or voluntary retirement under any of the Company's retirement plans as in effect from time to time. For purposes of this Agreement, Disability shall mean the Executive has met the conditions to qualify for long-term disability benefits under the Company's policies, as in effect immediately prior to the Effective Date.

  • Compensation Following Termination of Employment In the event that Executive's employment hereunder is terminated, Executive shall be entitled to the following compensation and benefits upon such termination:

  • Death, Retirement or Disability Executive’s employment shall terminate automatically upon Executive’s death or Retirement during the Employment Period. For purposes of this Agreement, “Retirement” shall mean normal retirement as defined in the Company’s then-current retirement plan, or if there is no such retirement plan, “Retirement” shall mean voluntary termination after age 65 with ten years of service. If the Company determines in good faith that the Disability of Executive has occurred during the Employment Period (pursuant to the definition of Disability set forth below), it may give to Executive written notice of its intention to terminate Executive’s employment. In such event, Executive’s employment with the Company shall terminate effective on the 30th day after receipt of such written notice by Executive (the “Disability Effective Date”), provided that, within the 30 days after such receipt, Executive shall not have returned to full-time performance of Executive’s duties. For purposes of this Agreement, “Disability” shall mean a mental or physical disability as determined by the Board of Directors of the Company in accordance with standards and procedures similar to those under the Company’s employee long-term disability plan, if any. At any time that the Company does not maintain such a long-term disability plan, “Disability” shall mean the inability of Executive, as determined by the Board, to perform the essential functions of his regular duties and responsibilities, with or without reasonable accommodation, due to a medically determinable physical or mental condition which has lasted (or can reasonably be expected to last) for twelve workweeks in any twelve-month period. At the request of Executive or his personal representative, the Board’s determination that the Disability of Executive has occurred shall be certified by two physicians mutually agreed upon by Executive, or his personal representative, and the Company. Failing such independent certification (if so requested by Executive), Executive’s termination shall be deemed a termination by the Company without Cause and not a termination by reason of his Disability.

  • Termination Due to Death, Disability or Retirement In the event the Optionee’s employment with the Company and all Subsidiaries is terminated by reason of death, Disability or Retirement, this Option will remain exercisable, to the extent exercisable as of the date of such termination, for a period of one year after such termination (but in no event after the Time of Termination).

  • No Right of Continued Employment I acknowledge and agree that nothing contained herein shall be construed as granting me any right to continued employment by the Company, and the right of the Company to terminate my employment at any time and for any reason, with or without cause, is specifically reserved.

  • Termination Because of Death or Disability If Participant is Terminated because of death or Disability of Participant, the Option, to the extent that it is exercisable by Participant on the date of Termination, may be exercised by Participant (or Participant's legal representative) no later than twelve (12) months after the date of Termination, but in any event no later than the Expiration Date.

  • Retirement, Death or Disability If the Executive’s employment terminates during the Term of this Agreement due to his death, a disability that results in his collection of any long-term disability benefits, or retirement at or after age 62, the Executive (or the beneficiaries of his estate) shall be entitled to receive the compensation and benefits that the Executive would otherwise have become entitled to receive pursuant to subsection (d) hereof upon a resignation without Good Reason.

  • Compensation Following Termination In the event that Executive’s employment hereunder is terminated, Executive shall be entitled only to the following compensation and benefits upon such termination:

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