Proposed Plan Benefit Packages Sample Clauses

Proposed Plan Benefit Packages. (PBPs) and Bids. The MCO will provide a copy of its CMS submitted SNP bid to the STATE’s contracted actuarial firm within thirty (30) days of submission to CMS for the purpose of assuring that the STATE does not duplicate payments on any provided services. The MCO will provide a copy of the MCO’s approved CMS bid to the STATE’s actuarial firm, if the approved bid differs significantly from the submitted bid. The STATE will not directly review this bid information. The MCO must identify information as trade secret prior to or at the time of its submission to the actuarial firm for the STATE to consider classifying such trade secret data as non-public, as described in section 9.6.
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Proposed Plan Benefit Packages. (PBPs) and Bids.‌ The MCO/SNP will provide a copy of its CMS submitted bid to the STATE’s actuarial firm within thirty (30) days of final submission to CMS for the purpose of assuring that the STATE does not duplicate payments on any provided services. The MCO will provide a copy of the MCO’s approved CMS bid to the STATE’s actuarial firm, if the approved bid differs significantly from the submitted bid. The STATE will not directly review this information. The MCO must identify information as “Trade Secret” prior to or at the time of its submission for the STATE to consider classifying it as non-public, as described in section 9.7.‌
Sample 1Sample 2See All (5)
Proposed Plan Benefit Packages. (PBPs) and Bids. The MCO/SNP will provide a copy of its CMS approved bid to the STATE’s actuarial firm within thirty (30) days of final CMS approval for the purpose of assuring that the STATE does not duplicate payments on any provided services. The STATE will not directly review this information. The MCO must identify information as trade secret prior to or at the time of its submission for the STATE to consider classifying it as non-public, as described in section 9.6.
Sample 1Sample 2

Related to Proposed Plan Benefit Packages

  • Basic Plan All services are subject to an annual deductible of $50 per person and $100 per family. Preventive services are covered at 100%. After paying the deductible, the plan provides usual, customary, and reasonable (UCR) coverage at 100% for diagnostic and restorative services, and 80% for major services. Orthodontia is not covered.

  • Dependent Care Salary Reduction Plan The Employer agrees to maintain the current dependent care salary reduction plan that allows eligible employees, covered by this Agreement, the option to participate in a dependent care reimbursement program for work-related dependent care expenses on a pretax basis as permitted by federal tax law or regulation.

  • Rollovers of Xxxx Elective Deferrals Xxxx elective deferrals distributed from a 401(k) cash or deferred arrangement, 403(b) tax-sheltered annuity, 457(b) eligible governmental deferred compensation plan, or federal Thrift Savings Plan, may only be rolled into your Xxxx XXX.

  • Oregon Public Service Retirement Plan Pension Program Members For purposes of this Section 2, “employee” means an employee who is employed by the State on or after August 29, 2003 and who is not eligible to receive benefits under ORS Chapter 238 for service with the State pursuant to Section 2 of Chapter 733, Oregon Laws 2003.

  • Sponsorship Benefits 3.1 INREV agrees to grant the Sponsor the above chosen and described sponsorship benefits.

  • Elective Deferrals An Employee will be eligible to become a Contributing Participant in the Plan (and thus be eligible to make Elective Deferrals) and receive Matching Contributions (including Qualified Matching Contributions, if applicable) after completing 1 (enter 0, 1 or any fraction less than 1) Years of Eligibility Service.

  • Covered Benefits and Services The Contractor shall provide to its Hoosier Healthwise members, at a minimum, all benefits and services deemed “medically reasonable and necessary” and covered by the IHCP, and included in the Indiana Administrative Code and under the Contract with the State. A covered service is considered medically necessary if it meets the definition as set forth in 405 IAC 5-2-17. The Contractor shall deliver covered services sufficient in amount, duration or scope to reasonably expect that provision of such services would achieve the purpose of the furnished services. Costs for these services are the basis of the Contractor’s capitation rate and are, therefore, the responsibility of the Contractor. Coverage may not be arbitrarily denied or reduced and is subject to certain limitations in accordance with CFR 438.210(a)(4), which specifies when Contractors may place appropriate limits on services:  On the basis of criteria applied under the State plan, such as medical necessity; or  For the purpose of utilization control, provided the services furnished are sufficient in amount, duration or scope to reasonably be expected to achieve the purpose for which the services are furnished.

  • Public Benefit It is Reaction Retail’s understanding that the commitments it has agreed to herein, and actions to be taken by Reaction Retail under this Settlement Agreement, would confer a significant benefit to the general public, as set forth in Code of Civil Procedure § 1021.5 and Cal. Admin. Code tit. 11, § 3201. As such, it is the intent of Reaction Retail that to the extent any other private party initiates an action alleging a violation of Proposition 65 with respect to Reaction Retail’s failure to provide a warning concerning exposure to DEHP prior to use of the Products it has manufactured, distributed, sold, or offered for sale in California, or will manufacture, distribute, sell, or offer for sale in California, such private party action would not confer a significant benefit on the general public as to those Products addressed in this Settlement Agreement, provided that Reaction Retail is in material compliance with this Settlement Agreement.

  • Membership Benefits The benefits of CamCare programs are available only while your membership is current and active. Benefits are term year specific so they can only be used during the current active plan agreement period. Members have the ability to change their plan from one plan to another but the plans cannot be unbundled. Each plan has been designed carefully to include those elements associated with the main intent of a particular plan.

  • Maintaining Eligibility for Employer Contribution The employer's contribution continues as long as the employee remains on the payroll in an insurance eligible position. Employees who complete their regular school year assignment shall receive coverage through August 31.

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