Retrospective Eligibility Periods Sample Clauses

Retrospective Eligibility Periods i. Health plan responsibility Under the MyCare contract, the health plans are not responsible for retrospective eligibility periods. Services during retrospective eligibility periods are provided on a fee-for-service basis.
Sample 1Sample 2
AutoNDA by SimpleDocs
Retrospective Eligibility Periods i. Health plan responsibility During the 2014 experience period, MCPs were not responsible for periods of retrospective eligibility. Under the ODM contract, beginning April 1, 2016, the MCPs will be responsible for retrospective eligibility periods when the beneficiary was previously enrolled with a MCP in the MMC program less than 90 days prior to re-enrolling with a MCP. ODM will provide capitation payments to the MCPs for beneficiaries meeting this criteria. We reviewed historical eligibility meeting the MCP retro-active eligibility criteria, as well as associated FFS expenses, and did not observe material or consistent cost differences between retro-active eligibility member months (meeting the specific 90 day criteria) and managed care member months. We have not adjusted the estimated benefit expense included in the rates for the retrospective eligibility policy change. Projected member months for calendar year 2016, with the exception of the HF/HST <1 M+F rate cell, were increased by 1.5% as a result of this policy change. FFS claims incurred during retrospective eligibility periods have been excluded from the base data.
Sample 1
Retrospective Eligibility Periods. (a) MCOP responsibility Under the ODM contract, beginning April 1, 2016, the MCOPs became responsible for retrospective eligibility periods when the beneficiary was previously enrolled with an MCOP in the MyCare program less than 90 days prior to re-enrolling with an MCOP. ODM will provide capitation payments to the MCOPs for beneficiaries meeting this criteria. Based on review of analyses performed for other Ohio Medicaid managed care programs, we do not consider this to be a material adjustment to the Opt-Out rates. We have not adjusted the estimated benefit expense included in the rates for the retrospective eligibility policy change.
Sample 1
Retrospective Eligibility Periods 
Sample 1Sample 2Sample 3See All (5)

Related to Retrospective Eligibility Periods

  • Overtime-Eligible Rest Periods ‌ The Employer and the Union agree to rest periods that vary from and supersede the rest periods required by WAC 000-000-000. Employees will be allowed rest periods of fifteen (15) minutes for each one-half (1/2) shift of four (4) or more hours worked at or near the middle of each one-half (1/2) shift of four (4) or more hours. Rest periods do not require relief from duty. Rest periods may not be used for late arrival or early departure from work and rest and meal periods will not be combined.

  • Overtime-Eligible Employees Rest Periods The Employer and the Union agree to rest periods that vary from and supersede the rest periods required by WAC 000-000-000. Employees will be allowed rest periods of fifteen

  • Overtime-Eligible Employees Unpaid Meal Periods The Employer and the Union agree to unpaid meal periods that vary from and supersede the unpaid meal period requirements required by WAC 000-000-000. Unpaid meal periods for employees working more than five (5) consecutive hours, if entitled, will be a minimum of thirty (30) minutes and will be scheduled as close to the middle of the work shift as possible, taking into account the Employer’s work requirements and the employee’s wishes. Employees working three (3) or more hours longer than a normal workday will be allowed an additional thirty (30) minute unpaid meal period. When an employee’s unpaid meal period is interrupted by work duties, the employee will be allowed to resume their unpaid meal period following the interruption, if possible, to complete the unpaid meal period. In the event an employee is unable to complete the unpaid meal period due to operational necessity, the employee will be entitled to compensation, which will be computed based on the actual number of minutes worked within the unpaid meal period. Meal periods may not be used for late arrival or early departure from work and meal and rest periods will not be combined.

  • Overtime-Eligible Unpaid Meal Periods ‌ The Employer and the Union agree to unpaid meal periods that vary from and supersede the unpaid meal period requirements of WAC 000-000-000. Unpaid meal periods for employees working more than five (5) consecutive hours, if entitled, will be a minimum of thirty (30) minutes and will be scheduled as close to the middle of the work shift as possible. Employees working three (3) or more hours longer than a normal workday will be allowed an additional thirty (30) minute unpaid meal period. When an employee’s unpaid meal period is interrupted by work duties, the employee will be allowed to resume their unpaid meal period following the interruption, if possible, to complete the unpaid meal period. In the event an employee is unable to complete the unpaid meal period due to operational necessity, the employee will be entitled to compensation, which will be computed based on the actual number of minutes worked within the unpaid meal period. Meal periods may not be used for late arrival or early departure from work and meal and rest periods will not be combined.

  • Continuing Eligibility To continue health benefits, a permanent intermittent employee must be credited with a minimum of 480 paid hours in a control period or 960 paid hours in two consecutive control periods.

  • Break Periods The parties agree that the paid rest period contemplated by Article 16(e) shall be taken during times that will not interfere with the operation of the Strong Start Centre.

  • Benefit Period Following the Qualifying Period you will receive a monthly income until the earlier of:

  • Disability Period The period in which an employee cannot continuously perform the essential duties of any position available in accordance with the priority placement criteria of the Rehabilitation and Re-employment Procedure.

  • 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.

  • Vacation Eligibility Employees shall be eligible for vacation, based on their Net Credited Service (NCS) with the Company, as follows:

Time is Money Join Law Insider Premium to draft better contracts faster.