Eligibility Determination and Disenrollment Sample Clauses

Eligibility Determination and Disenrollment. The State or its designee will make eligibility determinations for each potential enrollee for the Program. Should a Member become ineligible for Medicaid, HHSC will disenroll the Member from the managed care plan. If an MCO becomes aware that a Member has moved outside of the MCOs service area or that a Member is no longer Medicaid-eligible, for example the Member has moved outside of the state or is deceased, the MCO must inform HHSC within 10 Business Days.
Sample 1
AutoNDA by SimpleDocs
Eligibility Determination and Disenrollment. The HHSC Enrollment Broker determines Medicaid and CHIP eligibility. Should a Member become ineligible for Medicaid, HHSC will disenroll the Member from the managed care plan. If a Dental Contractor becomes aware that a Member has moved outside of the Dental Contractor service area or that a Member is no longer Medicaid-eligible, for example the Member has moved outside of the state or is deceased, the Dental Contractor must inform HHSC as soon as practicable. Dental Services for Texas Children’s Medicaid and Children’s Health Insurance Program Contract No. HHS0002879-00003 Attachment B – Dental Contract Terms and Conditions
Sample 1

Related to Eligibility Determination and Disenrollment

  • Eligibility Determination The State or its designee will make eligibility determinations for each of the HHSC HMO Programs.

  • Salary Determination 12.5.1 A unit member shall receive a salary not less than the minimum salary nor more than the maximum salary (Articles 12.3 and 12.4) for the rank to which appointed, except as provided in Articles 4.15, 5.6, 10.6.1 or Article 10.6.1.1. The effective dates for salaries shall be the appropriate dates specified in Article 12.2.2.

  • Determination of Eligibility The Plan Administrator shall determine the eligibility of each Employee for participation in the Plan based upon information provided by the Employer. Such determination shall be conclusive and binding on all individuals except as otherwise provided herein or by operation of law.

  • Order of Benefit Determination Rules When a Member is covered by two or more plans, the rules for determining the order of benefit payments are as follows:

  • Predetermination of Benefits If charges for a planned course of treatment by a licensed dentist would exceed $300.00, proposed details and x-rays should be submitted to the Plan Administrator for approval. Failure to do so may result in a payment of a lesser benefit amount because of the difficulty in determining the need for such treatment after it has been provided. Dental x-rays will be promptly returned to the dentist.

  • Determination of Agreement 29. (1) In any of the following events namely if —

  • Verification of Employment Eligibility By executing this Agreement, Consultant verifies that it fully complies with all requirements and restrictions of state and federal law respecting the employment of undocumented aliens, including, but not limited to, the Immigration Reform and Control Act of 1986, as may be amended from time to time, and shall require all subconsultants and sub-subconsultants to comply with the same.

  • Effective Date of Benefit Termination Medical, dental and life coverage termination will take effect on the first of the month following the loss of eligible employee or dependent status. Disability benefit coverage terminations will take effect on the day following loss of eligible employee status.

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • SALARY DETERMINATION FOR EMPLOYEES IN ADULT EDUCATION PCA Article B.3 does not apply in School District No. 34 (Abbotsford).

Time is Money Join Law Insider Premium to draft better contracts faster.