No Coverage a) Should the Company elect not to provide a replacement, but should it be necessary to call in an employee from the Call-in List for the purpose of correcting a specific breakdown, the employee called in is paid double time for the “Call-in”.
No Coverage. No change in options shall be permitted during the leave of absence unless there is a substantial change in the employee's family status. When a teacher returns to active employment on or before the 15th of the month, the Board of Education shall pay the full premium. If the teacher returns after the 15th of the month, he/she shall pay the full premium.
No Coverage o Coverage terminates for claims incurred after termination (as of the last date of the pay period) without continued participation by payment of employee premiums under extended medical coverage under DWHB or by electing normal COBRA benefits. DENTAL BENEFITS --------------- Normal COBRA Benefits --------------------- o Dental coverage my only be continued by electing COBRA continuation coverage for dental benefits no more than 60 days after termination of employment. Enrollment will be in the same dental plan which you were enrolled just prior to separation from RFETS. The effective date of COBRA continuation coverage will be the date following the last pay period after separation (which is the date that insurance coverage as an active employee terminates). o The separated employee pays the full COBRA rate for dental coverage monthly by personal check. Employees will be sent invoices by Mutual of Omaha, (Note: full, monthly premium payment will be required rather than a pro-rata amount for mid-month effective dates). Up to 18 months coverage is available as long as premium payments continue to be made to Mutual of Omaha. o If coverage is not elected within 60 days after termination of employment and/or premiums are not received by their due dates, coverage will terminate effective at the end of the last premiums payment period and cannot later be reinstated. o When continuing dental coverage through COBRA, you may add or delete dependents only upon the occurrence of a "qualifying event." Further information about COBRA is contained in the RFETS Summary Plan Descriptions. o COBRA rates are reviewed and revised each calendar year.
No Coverage. HMO determines that a service or supply is not covered by the plan. A service or supply is not covered if it is not included in the list of Covered Benefits; • A service or supply is excluded from coverage; • An HMO benefit limitation has been reached; or • Eligibility - HMO determines that the Subscriber or Subscriber’s Covered Dependents are not eligible to be covered by the HMO. Written notice of an adverse benefit determination will be provided to the Member and/or Member’s Provider within the time frames provided below. The times are measured from the HMO’s receipt of the information reasonably necessary and requested by the HMO to make the determination. These time frames may be extended, if the HMO has requested information which has not been received or, consistent with good medical practice, has requested consultation with an expert reviewer, or requested an additional examination or additional tests. In these cases the HMO will notify the provider and the enrollee in writing of the reasons why a decision cannot be made within the required timeframes and the anticipated date the decision can be made. The notice of adverse benefit determination will provide the information required by California law that will assist the Member in making an Appeal of the adverse benefit determination, if the Member wishes to do so. Additional information regarding the Member’s rights to Independent Medical Review for regarding denial of services determined to be Experimental or Investigative may be found in the Independent Medical Review section, Item A. California laws and rules regulate adverse benefit determinations as Disputed Health Care Services or Coverage Determinations. Please see the Complaints and Appeals section of this EOC for more information about Complaints and Appeals. HMO Timeframe for Decision and Notification Type of Claim HMO Time Frame for Decision HMO Time Frame for Notification of an Adverse Benefit Determination Urgent Care Claim. A claim for medical care or treatment where delay could seriously jeopardize the life or health of the Member, the ability of the Member to regain maximum function; or subject the Member to severe pain that cannot be adequately managed without the requested care or treatment. In a timely fashion appropriate to the nature of the condition not to exceed 72 hours of HMO’s receipt of the information reasonably necessary to make decision.
No Coverage. 8.1. The Company continuously examines the coverage of the securities account. If the quotient of the value of all collateral deposit provided by the Client and the total liabilities debiting the account does not reach the minimum amount specified by the Company in the Announcement, the Company is entitled to follow the liquidation order specified in the Announcement, sell either existing assets or the asset purchased from the loan and use the proceeds from the sale to reduce the Client’s outstanding loan amount (liquidation) to the extent that after the sale the quotient of the total collateral deposit and the total liabilities to the account reaches the limit.
No Coverage. No change in options will be permitted during the leave of absence unless there is a substantial change in the employee's family status. When an employee returns to active employment on or before the 15th of the month, the Board of Education will pay the full premium, minus the employee premium cost share currently in effect, for the month. If the employee returns after the 15th of the month, he/she will pay the full premium for the month.
