Plan Arrangements Eligibility – Claim Types All claim types are eligible to be processed through Inter-Plan Arrangements, as described above, except for all dental benefits, and those prescription drug benefits or vision benefits that may be administered by a third party contracted by us to provide the specific service or services. BlueCard® Program Under the BlueCard® Program, when you receive covered healthcare services within the geographic area served by a Host Blue, BCBSRI will remain responsible for doing what we agreed to in the contract. However, the Host Blue is responsible for contracting with and generally handling all interactions with its participating providers. When you receive covered healthcare services outside our service area and the claim is processed through the BlueCard Program, the amount you pay for covered healthcare services is calculated based on the lower of: • the billed covered charges for your covered services; or • the negotiated price that the Host Blue makes available to BCBSRI. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your healthcare provider. Sometimes, it is an estimated price that takes into account special arrangements with your healthcare provider or provider group that may include types of settlements, incentive payments and/or other credits or charges. Occasionally, it may be an average price, based on a discount that results in expected average savings for similar types of healthcare providers after taking into account the same types of transactions as with an estimated price. Estimated pricing and average pricing also take into account adjustments to correct for over- or underestimation of past pricing of claims, as noted above. However, such adjustments will not affect the price we have used for your claim because they will not be applied after a claim has already been paid. Negotiated (non–BlueCard Program) Arrangements With respect to one or more Host Blues, in certain instances, instead of using the BlueCard Program, we may process your claims for covered healthcare services through Negotiated Arrangements for National Accounts. The amount you pay for covered healthcare services under this arrangement will be calculated based on the negotiated price (refer to the description of negotiated price in the BlueCard® Program section above) made available to us by the Host Blue.
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions (a) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.
Health Benefits Eligibility a. The State System shall provide an eligible permanent full-time active employee with health benefits. The State System shall provide permanent part-time employees who are expected to be in an active pay status at least fifty (50%) of the time every pay period with health benefits.
Group Benefits Eligibility 7.2.1 Participation in the Plan shall be a condition of employment for all teachers commencing employment for a full school year.
Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.
Eligible Population 5.1 Program eligibility is determined by applicable law set forth in Program rules and the requirements established in the Program Policy Manual.
Benefits Eligibility The City offers healthcare benefits to regularly appointed full-time and part-time employees and their qualified dependents. The plan is administered in compliance with all applicable federal, state, local laws, statutes and rules.
Eligibility Requirements The Trustee hereunder shall at all times (i) be a corporation or association having its principal office in a state and city acceptable to the Seller, organized and doing business under the laws of such state or the United States of America, authorized under such laws to exercise corporate trust powers, having a combined capital and surplus of at least $50,000,000, or shall be a member of a bank holding system, the aggregate combined capital and surplus of which is at least $50,000,000, provided that its separate capital and surplus shall at all times be at least the amount specified in Section 310(a)(2) of the Trust Indenture Act of 1939, (ii) be subject to supervision or examination by federal or state authority and (iii) have a credit rating or be otherwise acceptable to the Rating Agencies such that neither of the Rating Agencies would reduce their respective then current ratings of the Certificates (or have provided such security from time to time as is sufficient to avoid such reduction) as evidenced in writing by each Rating Agency. If such corporation or association publishes reports of condition at least annually, pursuant to law or to the requirements of the aforesaid supervising or examining authority, then for the purposes of this Section the combined capital and surplus of such corporation or association shall be deemed to be its combined capital and surplus as set forth in its most recent report of condition so published. In case at any time the Trustee shall cease to be eligible in accordance with the provisions of this Section, the Trustee shall resign immediately in the manner and with the effect specified in Section 8.08.
Benefit Level Two Health Care Network Determination Issues regarding the health care networks for the 2017 insurance year shall be negotiated in accordance with the following procedures:
Eligibility Exclusions Subject to Clause 2.5 of this Schedule 1, an individual is not eligible for training subsidised through the Skills First Program under this VET Funding Contract if the individual is: a student enrolled in a school (excluding a school based Apprentice/Trainee). This includes: any government, non-government, independent or Catholic school; or a student registered for home schooling in Victoria. Government schools are responsible for funding these opportunities for VET within the school curriculum through their Student Resource Package (SRP) allocation, including targeted VET in schools funding. Non-government schools make similar decisions for students on the basis of the resources available to them; within the meaning of the Corrections Act 1986 (Vic), a prisoner held at a prison, including: Xxxxxxx Correctional Centre (Ararat); Barwon Prison; Beechworth Correctional Centre; Dame Xxxxxxx Xxxxx Centre; Dhurringile Prison; Langi Kal Kal Prison; Loddon Prison Precinct; Marngoneet Correctional Centre; Tarrengower Prison; Metropolitan Remand Centre; Melbourne Assessment Prison; Fulham Correctional Centre; Port Xxxxxxx Prison; or Karrenga Annex; a person who is detained under the Mental Health Act 2014 (Vic), or the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (Vic) or the Sentencing Act 1991 (Vic) at the Xxxxxx Xxxxxxx Hospital; or a person who is detained (other than on weekend detention) under the Children, Youth and Families Act 2005 (Vic) or the Sentencing Act 1991 (Vic) or who is held on remand in one or more of the following youth justice facilities: Malmsbury Youth Justice Centre; Parkville Youth Residential Centre; or Melbourne Youth Justice Centre. The exclusions described in Clauses 2.4(b), (c) and (d) of this Schedule 1 do not apply to: young people on community based orders made under the Children, Youth and Families Act 2005 (Vic); or individuals held in Xxxx Xxxxxxx Transition Centre, who, subject to otherwise complying with the requirements in this Clause 2, may be eligible for training subsidised through the Skills First Program as they are able to physically access training outside of a custodial setting without supervision.
