Newborns Clause Samples
The 'Newborns' clause establishes specific terms and conditions that apply to newborn children within the context of the agreement. Typically, this clause outlines eligibility, coverage, or benefits for newborns, such as automatic enrollment in a health plan or immediate coverage from birth. Its core function is to ensure that newborns are promptly and appropriately included under the relevant provisions, thereby preventing gaps in coverage or ambiguity regarding their status.
Newborns. 4.2.5.1 When a child is born to a mother enrolled in Centennial Care, the hospital or other provider shall complete a Notification of Birth, MAD Form 313, or its successor, prior to or at the time of discharge. HSD shall ensure that upon receipt of the MAD Form 313 the eligibility process is immediately commenced and that upon completion of the eligibility process the newborn is enrolled into his or her mother’s MCO.
4.2.5.2 Medicaid eligible newborns are eligible for a period of thirteen (13) months, starting with the month of birth. The newborn shall be enrolled retroactively to the month of birth with the mother’s MCO.
4.2.5.3 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is also a Centennial Care MCO, the newborn shall be enrolled retroactively to the month of birth with that Centennial Care MCO.
4.2.5.4 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is not a Centennial Care MCO, the newborn shall be auto assigned and enrolled in a Centennial Care MCO (in accordance with Section 4.2.4 of this Agreement) retroactively to the month of birth. The mother shall have one (1) opportunity anytime during the three (3) months from the effective date of enrollment to change the newborn’s MCO assignment.
4.2.5.5 Newborns are not considered part of the retroactive reconciliation period if the mother of the newborn is enrolled in Centennial Care at the time of delivery.
Newborns. 4.2.6.1 When a child is born to a mother enrolled in Turquoise Care, the hospital or other Provider shall notify the HCA of the child’s birth. Hospitals or other Providers shall notify HCA by either using the electronic process available through the Baby Bot program (or its successor) or by completing a Notification of Birth, MAD Form 313 (or its successor) prior to or at the time of discharge. Upon receipt of the notification of the child’s birth, HCA shall ensure that the eligibility process is immediately commenced and that upon completion of the eligibility process the newborn is enrolled into their mother’s MCO.
4.2.6.2 Medicaid eligible newborns are eligible for a period of thirteen (13) months, starting with the month of birth. The newborn shall be enrolled retroactively to the month of birth with the mother’s MCO.
4.2.6.3 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is also a Turquoise Care MCO, the newborn shall be enrolled retroactively to the month of birth with that Turquoise Care MCO.
4.2.6.4 When a Medicaid-eligible child is born to a mother on the New Mexico Health Insurance Exchange and the mother’s Qualified Health Plan is not a Turquoise Care MCO, the newborn shall be auto-assigned and enrolled in a Turquoise Care MCO (in accordance with Section 4.2.5 of this Agreement) retroactively to the month of birth. The mother shall have one (1) opportunity anytime during the three (3) months from the effective date of enrollment to change the newborn’s MCO assignment.
4.2.6.5 Newborns are not considered part of the retroactive reconciliation period if the mother of the newborn is enrolled in Turquoise Care at the time of delivery.
Newborns. For the Traditional Attribution Cohort, children born to an Attributed Member mother after September 30 prior to the Performance Year, will not be attributed to Contractor in the Performance Year. For the Expanded Attribution Cohort, children born to an Attributed Member mother after October 30 prior to the Performance Year will not be attributed to Contractor in the Performance Year.
Newborns. The STATE will pay to the MCO a Capitation Payment for the birth month of an eligible newborn Enrollee if the mother was enrolled in the MCO during the month of the Child’s birth and eligibility is established for the Child. Payment for succeeding months will be determined pursuant to section 3.1.3,
Newborns. 3.2.2.7.1 Newborns born to mothers who are DSHP or DSHP Plus members at the time of the child’s birth will be Enrolled in their mother’s MCO. If the mother is not Enrolled with an MCO but the child is eligible for Medicaid or CHIP, the birth is covered by fee-for-service Medicaid or CHIP, and the child and the mother will be Enrolled in the same MCO.
3.2.2.7.2 The Contractor shall provide Covered Services for eligible newborns retroactive to the date of birth.
3.2.2.7.3 The newborn’s mother or guardian may request the newborn’s Transfer without cause within the first 90 calendar days (see Section
Newborns. (1) Mother Enrolled with the MCO under this Contract. Eligible newborns born to mothers enrolled in the MCO under this Contract will be enrolled in the same MCO as the mother for the birth month in accordance with STATE policies and procedures, unless the newborn at the time of enrollment meets one of the exclusion reasons listed in section 3.1.1(C).
(2) Mother Enrolled with the MCO under MSHO, MSC+ or SNBC and the MCO has a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother who is enrolled with the MCO under MSHO, MSC+ or SNBC and the MCO has a program covered by this Contract in that same Service Area, the newborn will be enrolled in the MCO under this Contract in that service area for the birth month in accordance with STATE policies and procedures, unless the newborn at the time of enrollment meets one of the exclusion reasons listed in section 3.1.1(C).
(3) Mother Enrolled with the MCO under MSHO, MSC+ or SNBC and the MCO does not have a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother enrolled with the MCO under MSHO, MSC+ or SNBC but the MCO does not have a program covered by this Contract in that same Service Area, the newborn will be enrolled in accordance with STATE policies and procedures.
(4) Enrollment within Ninety Days. If a request to enroll a newborn (described in 3.1.3(B)(1) or (2) above) in the MCO is received within ninety (90) days of the birth, the MCO will receive a capitation payment for the birth month and the succeeding months as long as the newborn remains eligible, does not meet an exclusion from enrollment, and there is not a request to change to another MCO. If a request to enroll a newborn described in section (3.1.3(B)(1) or (2) above) in the MCO is not received within ninety (90) days of the birth, the MCO will receive a capitation payment for the birth month only, and the newborn will be enrolled in the MCO for the next available month unless a change of MCOs is requested.
Newborns. Babies born to SCHIP members are not automatically eligible. A separate application must be filed and an eligibility determination must be made by SCDHHS. See the Policy and Procedure Guide.
Newborns. (1) Mother Enrolled with the MCO Under This Contract. Eligible newborns born to mothers enrolled in the MCO under a program covered by this Contract will be enrolled in the same MCO as the mother for the birth month in accordance with STATE policies and procedures, unless the newborn meets one of the exclusion reasons listed in section 3.1.1(D).
(2) Mother Enrolled with the MCO Under MSHO, MnDHO or SNBC and the MCO has a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother who is enrolled with the MCO under MSHO, ▇▇▇▇▇, or SNBC and the MCO has a program covered by this Contract in that same Service Area, the newborn will be enrolled in the MCO under a program covered by this Contract in that service area for the birth month in accordance with STATE policies and procedures, unless the newborn meets one of the exclusion reasons listed in section 3.1.1(D).
(3) Mother Enrolled with the MCO Under MSHO or SNBC and the MCO does not have a Program Covered by this Contract in the Same Service Area. If an eligible newborn is born to a mother enrolled with the MCO under MSHO or SNBC but the MCO does not have a program covered by this Contract in that same Service Area, the newborn will be enrolled in accordance with STATE policies and procedures.
Newborns. Newborn statistics will not be part of the All Other admissions or of the performance calculation. However, COMPARE will still review these admissions. Once the exact nature of 30 the CARRIER data base coding for newborns is determined, Wyat▇ ▇▇▇ COMPARE will agree on a suitable definition (such as a minimum claimant aqe on admission of 6 months) for exclusion of newborn claims from the All Other pool.
Newborns a) The Passenger may travel after 48 hours from birth if he was full-term (born at 38 weeks gestation or later) and no complications occurred (during pregnancy, birth and since birth) ;
b) The Passenger shall not travel if he was pre-term (less than 38 weeks gestation) and/or if complica- tions occurred (during pregnancy, birth and/or since birth), unless the Carrier is provided with a medical certificate from a pediatrician (satisfactory to the Carrier) dated not earlier than 10 days before the first Flight. Any Passenger who is pregnant or travels with a newborn shall inform the Carrier accordingly in advance (the Client shall have the same obligation for any Passenger). The Client and the Passengers acknowledge and agree that the Carrier has the right to impose any further restrictions on the carriage of any pregnant or newborn Passenger if it considers in its sole discretion that such restrictions are necessary for the safety of the Passenger. Revision 0 - September 2020 - 3/12 Article 5 : Client’s and Passengers’ Obligations The Client shall indicate to the Carrier the identity of all Passengers sufficiently in advance before the first Flight and shall communicate to the Carrier all information and documents related to the Passengers as may be requested by the Carrier (through AASA) ; in particular, immediately upon receipt of the Flight Confirmation, the Client shall provide the Carrier with all PNR Data requested in annex to the Flight Confirmation. In case of failure or delay by the Client to comply with such obligations for any reason whatsoever, AASA shall be entitled to treat such failure or delay as constituting a cancellation entitling AASA to the payment of the amounts set out in Article 8 (including the applicable Cancellation Fee (as defined below)). The Passengers shall not smoke onboard the Aircraft unless it is expressly confirmed by AASA and/or the Carrier that the Aircraft is a smoking aircraft. The Client and the Passengers shall comply with all laws, regulations, orders, demands and travel requirements of countries to be flown from, into or over (including immigration, customs and agriculture regulations) and with the Carrier’s rules and instructions pertaining hereto. In particular, the Passengers shall be solely responsible for carrying a valid passport, obtaining any visa where required and ensuring the accuracy of any required document or information. AASA bears no liability for the consequences to any Passenger resulting from hi...