Medicare Beneficiaries Sample Clauses

Medicare Beneficiaries. Enrollees who become eligible for Medicare will be disenrolled effective the first of the month of notification to the Medicaid and BadgerCare programs from the Social Security Administration (SSA). Even if SSA awards Medicare eligibility retroactively, the effective date of HMO disenrollment will be the first of the month of notification.
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Medicare Beneficiaries. If you are a patient who is entitled to benefits under or is enrolled in Medicare Part B, you acknowledge that HIM has not been excluded from participation under the Medicare program and understand that HIM has voluntarily elected to opt out of the Medicare program. You agree not to submit a claim or request HIM submit a claim under the Medicare program or to any intermediary or carrier of the Medicare Program for any portion of the membership fee or physician services billed to you by HIM even if the services are covered by Medicare. You acknowledge that you will be responsible for payment of such services and that no reimbursement will be provided under the Medicare program or any Medigap plan for the membership fee or xxxx for physician services and that other supplemental insurance plans may elect not to reimburse you for such items. You further acknowledge that the limits the Medicare program places on what a physician participating in the Medicare program may charge for services rendered do not apply to the membership fee or to any physician services xxxx rendered to you by HIM. Further, you acknowledge that (a) you have the right to obtain Medicare-covered services from physicians who have not opted out of the Medicare program, (b) you are currently not facing an emergency or urgent healthcare situation, and (c) you have voluntarily elected to enter into this membership agreement for the provision by HIM of services that might be eligible for payment or reimbursement by Medicare if the services were provided by a physician who continued to participate in the Medicare program subject to the submission of an appropriate Medicare claim.
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Medicare Beneficiaries. If Patient is eligible for Medicare, or during the term of this Agreement becomes eligible for Medicare, then Patient understands that the Practice and Providers do not accept Medicare for the services rendered at SHD. Patient’ understands Medicare cannot be billed for any services performed for the Patient by the Practice. By signing this agreement Patient agrees not to xxxx Medicare or attempt Medicare reimbursement for the Services.
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Medicare Beneficiaries. By signing this Agreement, you specifically acknowledge that pursuant to federal regulations, Medicare Beneficiaries are not permitted to enter into this Agreement. If you are eligible for Medicare, or during the term of this Agreement you become eligible for Medicare, then you must immediately notify Practice. This Agreement will automatically terminate commensurate with your Beneficiary eligibility status and any refundable Monthly Fee will be returned to you, or applied to your financial obligations as a Beneficiary, as the case may be, subject to any applicable regulatory restrictions. You specifically agree that you will not xxxx Medicare or attempt Medicare reimbursement for any Services provided under this Agreement.
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Medicare Beneficiaries. If Patient is eligible for Medicare, or during the term of this Agreement becomes eligible for Medicare, then Patient will sign Appendix A to this Agreement, attached hereto and incorporated by reference. Appendix A documents Patient’s understanding that all Physicians employed by the Practice have opted out of Medicare, and as a result, Medicare cannot be billed for any services performed for Patient by the Practice. By signing Appendix A, Patient agrees not to xxxx Medicare or attempt Medicare reimbursement for the Services.
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Related to Medicare Beneficiaries

  • Health Care Benefits (a) Each regular full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:

  • 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)

  • Beneficiaries The Executive may designate one or more persons or entities as the primary and/or contingent Beneficiaries of any Severance Benefits owing to the Executive under this Agreement. Such designation must be in the form of a signed writing acceptable to the Committee. The Executive may make or change such designations at any time.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Intended Beneficiaries Nothing in this Agreement shall be construed to give any person or entity other than the parties hereto any legal or equitable claim, right or remedy. Rather, this Agreement is intended to be for the sole and exclusive benefit of the parties hereto.

  • Retiree Benefits Employees retiring on or after January 1, 2006 will be eligible for retiree benefits as presented to the Union Negotiation Committee during discussions for renewal of the Collective Agreements that expired December 31, 2002.

  • Health & Welfare Benefits Executive shall be eligible to participate in all health and welfare benefits provided generally to other employees of the Company.

  • Retiree Health Insurance Retired members of the Department receiving, or to receive City of Lincoln monthly pension checks, may participate in the group comprehensive health care plan for active City employees, provided that each retiree so desiring will execute the required forms in a timely fashion, and further provided that each retiree will be required to pay the full monthly cost at the current rates subject to any rate increases which may occur from time to time. Such payment will be made by payroll deduction from pension checks, or by direct payment in the case of an early retiree.

  • Welfare Benefits Subject to the terms and conditions of this Agreement, for a period of twelve (12) months following the date of Involuntary Termination (and an additional twelve (12) months if the Executive provides consulting services under Section 14(f) hereof), the Executive and his dependents shall be provided with life, disability, accident and group medical benefits which are substantially similar to those provided to the Executive and his dependents immediately prior to the date of Involuntary Termination or the Change in Control Date, whichever is more favorable to the Executive. Without limiting the generality of the foregoing, the continuing benefits described in the preceding sentence shall be provided on substantially the same terms and conditions and at the same cost to the Executive as in effect immediately prior to the date of Involuntary Termination or the Change in Control Date, whichever is more favorable to the Executive. Such benefits shall be provided in a manner that complies with Treasury Regulation Section 1.409A-1(a)(5). Notwithstanding the foregoing, if Sempra Energy determines in its sole discretion that the portion of the foregoing continuing benefits that constitute group medical benefits cannot be provided without potentially violating applicable law (including, without limitation, Section 2716 of the Public Health Service Act) or that the provision of such group medical benefits under this Agreement would subject Sempra Energy or any of its Affiliates to a material tax or penalty, (i) the Executive shall be provided, in lieu thereof, with a taxable monthly payment in an amount equal to the monthly premium that the Executive would be required to pay to continue the Executive’s and his covered dependents’ group medical benefit coverages under COBRA as then in effect (which amount shall be based on the premiums for the first month of COBRA coverage) or (ii) Sempra Energy shall have the authority to amend the Agreement to the limited extent reasonably necessary to avoid such violation of law or tax or penalty and shall use all reasonable efforts to provide the Executive with a comparable benefit that does not violate applicable law or subject Sempra Energy or any of its Affiliates to such tax or penalty.

  • Medicare If the Resident meets the eligibility requirements for skilled nursing facility benefits under the Medicare Part A Hospital Insurance Program, the Facility will bill Medicare directly for Part A services provided to the Resident. Medicare will reimburse the Facility a fixed per diem or daily fee based on the Resident’s classification within the Medicare RUG IV guidelines or successor guidelines thereto. If the Resident continues to be eligible, Medicare may provide coverage of up to 100 days of care. The first 20 days of covered services are fully paid by Medicare and the next 80 days (days 21 through 100) of the covered services are paid in part by Medicare and subject to a daily coinsurance amount for which the Resident is responsible. A Resident with Medicare Part B and/or Part D coverage, who subsequently exhausts his/her Part A coverage or no longer needs a skilled level of care under Part A, may still be eligible to receive coverage for certain Part B services (previously included in the Part A payment to the Facility) and/or Part D services when Part A coverage ends. Medicare will terminate coverage for Medicare beneficiaries receiving physical, occupational and/or speech therapy (“therapy services”) if the Resident does not receive therapy for three (3) consecutive days, whether planned or unplanned, for any reason, including illness or refusals, doctor appointments or religious holidays. If such therapy was the basis for Medicare Part A coverage, the Resident would be responsible for the cost of his/her stay, unless another payor source is available. If Medicare denies coverage and denies further payment and/or recoups any payment made to the Facility, the Resident, Resident Representative, and/or Sponsor hereby agree to pay to the Facility any outstanding amounts for unpaid services not covered by other third party payers, subject to applicable federal and state laws and regulations. Such amounts shall be calculated in accordance with the Facility’s applicable prevailing private rates and charges for all basic and additional services provided to the Resident. Except for specifically excluded services, most nursing home services are covered under the consolidated billing requirements for Medicare Part A beneficiaries or under an all-inclusive rate for other third party insurers and managed care organizations (MCOs). Under these requirements, the Facility is responsible for furnishing directly, or arranging for, the services for its residents covered by Medicare Part A and MCOs. When not directly providing services, the Facility is required to enter into arrangements with outside providers and must exercise professional responsibility and control over the arranged-for services. All services that the Resident requires must be provided by the Facility or an outside provider approved by the Facility. Before obtaining any services outside of the Facility, the Resident must consult the Facility. While the Resident has the right to choose a health care provider, the Resident understands that by selecting the Facility, the Resident has effectively exercised his/her right of free choice with respect to the entire package of services for which the Facility is responsible under the consolidated billing and third party billing requirements. The Resident agrees that he/she will not arrange for the provision of ancillary services unless the Resident has obtained prior approval from the Facility. MEDICARE PART A, MANAGED CARE, AND THIRD-PARTY INSURANCE

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