Step-by-step Sample Clauses

Step-by-step. How to ask for a coverage decision (how to ask our plan to authorize or provide the medical care coverage you want) Legal Terms When a coverage decision involves your medical care, it is called an “organization determination.”
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Step-by-step. How to make a Level 1 Appeal (how to ask for a review of a medical care coverage decision made by our plan) Legal When you start the appeal process by Terms making an appeal, it is called the “first level of appeal” or a “Level 1 Appeal.” An appeal to the plan about a medical care coverage decision is called a plan “reconsideration.”
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Step-by-step. How to make a Level 1 Appeal to have our plan cover your care for a longer time If you want to ask us to cover your care for a longer period of time, you will need to use the appeals process to make this request. Before you start, understand what you need to do and what the deadlines are. • Follow the process. Each step in the first two levels of the appeals process is explained below. • Meet the deadlines. The deadlines are important. Be sure that you understand and follow the deadlines that apply to things you must do. There are also deadlines our plan must follow. (If you think we are not meeting our deadlines, you can file a complaint. Section 9 of this chapter tells you how to file a complaint.) • Ask for help if you need it. If you have questions or need help at any time, please call Customer Service (phone numbers are on the front cover of this booklet). Or call your State Health Insurance Assistance Program, a government organization that provides personalized assistance (see Section 2 of this chapter). During a Level 1 Appeal, the Quality Improvement Organization reviews your appeal and decides whether to change the decision made by our plan. Legal When you start the appeal process by making an appeal, Terms it is called the “first level of appeal” or “Level 1 Appeal.” Step 1: Make your Level 1 Appeal: contact the Quality Improvement Organization in your state and ask for a review. You must act quickly. What is the Quality Improvement Organization? • This organization is a group of doctors and other health care experts who are paid by the Federal government. These experts are not part of our plan. They check on the quality of care received by people with Medicare and review plan decisions about when it’s time to stop covering certain kinds of medical care. How can you contact this organization? • The written notice you received tells you how to reach this organization. What should you ask for? • Ask this organization to do an independent review of whether it is medically appropriate for our plan to end coverage for your medical services. Your deadline for contacting this organization. • You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care. • If you miss the deadline for contacting the Quality Improvement Organization about your appeal, you can make your appeal directly to our plan instead. For details about this...
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Related to Step-by-step

  • Fourth Step If the Association is not satisfied with the disposition of the grievance at Step Three, the Association may submit the grievance to final and binding arbitration through the American Arbitration Association, which shall act as the administrator of the proceedings. If a demand for arbitration is not filed with the American Arbitration Association within thirty (30) days of the date for the Step Three Answer, then the grievance shall be deemed withdrawn. The fees and the expenses of the arbitrator shall be shared equally by the parties. The arbitrator shall have no power to alter the terms of this Agreement. STATEMENT OF BASIC PRINCIPLES‌

  • First Step If a dispute cannot be resolved by this method, the Accredited Union Representative may file a formal grievance on the prescribed form with EPSCA/the Employer within fifteen (15) working days of the alleged grievous act. Within ten (10) working days of the filing of the grievance, EPSCA/the Employer shall investigate the grievance and convene a First Step meeting which he or the Accredited Union Representative considers necessary to resolve it. The Management Committee shall be comprised of EPSCA or their designate plus at least one representative of the Employer named in the grievance. The Union Committee shall include at least two persons, one of whom shall be the Accredited Union Representative for the grievor. EPSCA/the Employer shall give his reply on the prescribed form to the Accredited Union Representative within five (5) working days from the date of the First Step meeting. Copies of completed grievance forms signed by the appropriate parties shall be filed by EPSCA/the Employer with the General Manager of EPSCA. The Accredited Union Representative for the grievor will file a copy with the Union. The EPSCA/the Employer will send a copy of any signed first step grievance settlement between the Accredited Union Representative and EPSCA/the Employer to the Union and EPSCA office.

  • Consummation of Sale and Purchase During the Supplemental Purchase Period with respect to the Additional Loans (and thereafter with respect to Substituted Loans), the sale and purchase of Eligible Loans pursuant to an Additional Purchase Agreement shall be consummated upon (i) Funding's receipt from VL Funding and the VL Funding Eligible Lender Trustee of a fully executed copy of the related Additional Purchase Agreement; and (ii) the payment by Funding to VL Funding of the related Purchase Price. Upon consummation, such sale and purchase shall be effective as of the date of the related Additional Xxxx of Sale. VL Funding and Funding shall use their best efforts to perform promptly their respective obligations pursuant to the related Additional Purchase Agreement with respect to each Additional Loan.

  • STEP The Xxxxxxx shall inform the Committee Person of the response and the concern shall be reduced to writing by the Committee Person. This will be written on the form provided by the Company signed by the employee and shall then constitute a grievance. All grievances should identify, as far as possible, the article, clause or clauses of this agreement, or applicable legislation claimed to have been violated. The Shift Committee Person and if requested Xxxxx Xxxxxxx may present the grievance of the employee to the Operations Manager or designate within five (5) days after the receipt of the reply of the Supervisor or designate. At this stage the grievance shall be discussed between the on shift Committee Person, the Xxxxxxx if requested by either party and the Operations Manager or designate. The Operations Manager designate shall give a written response including an explanation of the decision rendered within seven (7) days of receipt of the grievance. Failing Settlement: Step The grievance shall be referred to the Human Resources department within seven (7) days by the Chairperson. The grievance shall be discussed by the Director of Human Resources or designate, the Senior Director of Operations or designate, the Chairperson and the shift committee The Local President, National representative, the Shift Xxxxxxx or if requested by either party to discuss the matter may attend the meeting. The Employer or the Union may file a policy commencing at Step In the case of discharge, a grievance may be filed by an employee who feels he was unjustly dealt with. Such a grievance must be filed within seven (7) days from the date of dismissal and shall commence at Step In any subsequent disposal of this case during the grievance procedure, the Employer may reinstate the employee, suspend the employee for a definite period, or sustain the discharge, if mutually agreed to by the parties to this Agreement. If an agreement cannot be reached the matter may be referred through the provisions of Article Should the grievance involve the alleged misinterpretation or violation of the Agreement of applicable government legislation, either party may be free to appeal to arbitration or within thirty-one (31) days from the date of the Step response. The parties shall attempt to agree on a single arbitrator or If the parties agree on the arbitrator or the party requesting the referral shall then refer the grievance to the chosen party with a statement of the issue to be arbitrated upon by if requested. Notice of said referral and a copy of said statement shall be forwarded simultaneously to the other party. The decision of the arbitrator or shall be final and binding upon all parties involved. Upon any decision rendered by the arbitrator it is agreed that the Chairperson and the company representative will review the decision if requested by either The arbitrator or as the case may be, shall not have any jurisdiction to alter or modify any of the provisions of this Agreement, nor to substitute any new provision in lieu thereof, nor to make any decision inconsistent with the terms and provisions of this Agreement. I In determining any discharge or any other disciplinary grievance, the arbitrator or as the case may be, shall have the authority to:

  • Consummation of Sale Upon Closing in Escrow, subject to the terms and conditions of this Agreement, the Company will be obligated to purchase the Stock, and the Shareholders will be obliged to sell the Stock, at the purchase price specified in Section 1.3 below, on the Closing Date specified in Section 1.4 below.

  • Consummation of Agreement Buyer shall fulfill and perform in all material respects all conditions and obligations to be fulfilled and performed by Buyer under this Agreement and make every reasonable effort to cause the transactions contemplated by this Agreement to be fully carried out.

  • Assumption or Termination of Sub-Servicing Agreements by Trustee In the event the Master Servicer shall for any reason no longer be the master servicer (including termination due to a Master Servicer Event of Default), the Trustee or its designee shall thereupon assume (or cause its designee or the successor master servicer for the Trustee appointed pursuant to Section 7.02 to assume) all of the rights and obligations of the Master Servicer under each Sub-Servicing Agreement that the Master Servicer may have entered into, unless the Trustee elects to terminate any Sub-Servicing Agreement in accordance with its terms as provided in Section 6.07. Upon such assumption, the Trustee, its designee or the successor servicer for the Trustee appointed pursuant to Section 7.02 shall be deemed, subject to Section 6.07, to have assumed all of the Master Servicer's interest therein and to have replaced the Master Servicer as a party to each Sub-Servicing Agreement to the same extent as if each Sub-Servicing Agreement had been assigned to the assuming party, except that (i) the Master Servicer shall not thereby be relieved of any liability or obligations under any Sub-Servicing Agreement and (ii) none of the Trustee, its designee or any successor Master Servicer shall be deemed to have assumed any liability or obligation of the Master Servicer that arose before it ceased to be the Master Servicer. The Master Servicer at its expense shall, upon request of the Trustee, deliver to the assuming party all documents and records relating to each Sub-Servicing Agreement and the Mortgage Loans then being serviced and an accounting of amounts collected and held by or on behalf of it, and otherwise use its best efforts to effect the orderly and efficient transfer of the Sub- Servicing Agreements to the assuming party.

  • Amendments to Servicing Agreements, Modification of Standard Provisions (a) Subject to the prior written consent of the Trustee pursuant to Section 3.07(b), the Master Servicer from time to time may, to the extent permitted by the applicable Servicing Agreement, make such modifications and amendments to such Servicing Agreement as the Master Servicer deems necessary or appropriate to confirm or carry out more fully the intent and purpose of such Servicing Agreement and the duties, responsibilities and obligations to be performed by the Servicer thereunder. Such modifications may only be made if they are consistent with the REMIC Provisions, as evidenced by an Opinion of Counsel. Prior to the issuance of any modification or amendment, the Master Servicer shall deliver to the Trustee such Opinion of Counsel and an Officer's Certificate setting forth (i) the provision that is to be modified or amended, (ii) the modification or amendment that the Master Servicer desires to issue and (iii) the reason or reasons for such proposed amendment or modification.

  • NEXT STEPS If you disagree with my findings you may request a hearing to appeal the decision by contacting me using the details provided. If you would like to discuss your application or if there is any confusion on how to proceed, you can write to, e-mail or telephone me. My contact details are shown at the top of this letter. Failure to Respond If you fail to respond by the date given above, your application will be refused under Section 3A(4) of the Registered Designs Act 1949.

  • Enforcement of Due-on-Sale Clauses; Assumption and Modification Agreements; Certain Assignments (a) When any Mortgaged Property is conveyed by the Mortgagor, the Master Servicer or Subservicer, to the extent it has knowledge of such conveyance, shall enforce any due-on-sale clause contained in any Mortgage Note or Mortgage, to the extent permitted under applicable law and governmental regulations, but only to the extent that such enforcement will not adversely affect or jeopardize coverage under any Required Insurance Policy. Notwithstanding the foregoing:

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