Stop Loss Program Sample Clauses

Stop Loss Program. (1) For the Stop Loss Program Charges set forth in Part D below, Blue Shield shall reimburse Group for eighty percent (80%) of that portion of the Allowable Costs (as described herein) of Capitated Professional Services provided during any one (1) Agreement Year to any one (1) Member which exceeds the Attachment Level and which are Group’s financial responsibility under the Agreement.
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Stop Loss Program. PROVIDER's Stop Loss threshold shall be ----------------- $50,000.00 per Medicare Risk Member during the contract year of the Agreement (each April 1st through each March 31st). If the PROVIDER projects the costs of providing services to a Member will reach the $50,000.00 threshold, PROVIDER shall refer the Member to HMO's Care Management Department, at point of determination. PROVIDER shall submit claims under the applicable stop loss program no later than sixty (60) calendar days following those days of service which occur beyond the threshold. Failure to submit claims in a timely manner may result in forfeiture of PROVIDER's right to reimbursement. For purposes of determining if the stop loss threshold has been reached, the compensation schedule set forth in Fee-For-Service Addendum shall be the source rates for calculation. HMO shall compensate PROVIDER for claims in excess of the stop loss threshold at eighty percent (80%) of the Fee-for-Service rates in the applicable Addendum, except for drugs which will be reimbursed at AWP minus ten percent (10%), less applicable Copayments, coinsurance, deductibles and payments from third parties or coordination of benefits.
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Stop Loss Program 
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Related to Stop Loss Program

  • Safety Program The Contractor shall design a specific safety program for the Work for the site(s). The Contractor shall establish and require all Subcontractors to establish reasonable safety programs. The Contractor shall also submit its standard monthly safety reports to the Owner and Design Professional. No imposition of responsibility on the Contractor for safety under this Contract shall relieve any subcontractor of its responsibility for safety of persons or property on or near the Project Site. The Contractor shall include in his plant he names of the person in charge of Safety.

  • Program 3.01 The Recipient declares its commitment to the Program and its implementation. To this end:

  • Insurance Programs 1. The District agrees to provide a program of life, medical and dental insurance benefits for teachers. The District shall offer each employee a choice between the following two (2) programs of medical and health care:

  • PROCUREMENT CARD The State has entered into an agreement for purchasing card services. The Purchasing Card enables Authorized Users to make authorized purchases directly from a Contractor without processing Purchase Orders or Purchase Authorizations. Purchasing Cards are issued to selected employees authorized to purchase for the Authorized User and having direct contact with Contractors. Cardholders can make purchases directly from any Contractor that accepts the Purchasing Card. The Contractor shall not process a transaction for payment through the credit card clearinghouse until the purchased Products have been shipped or services performed. Unless the cardholder requests correction or replacement of a defective or faulty Product in accordance with other Contract requirements, the Contractor shall immediately credit a cardholder’s account for Products returned as defective or faulty.

  • Program Review The Contracting Officer or other authorized government representative may hold semi- annual program review meetings. Such meetings will be held via telecom or video teleconferencing. However, the Government reserves the right to request a meeting in person. The meetings will include all BPA holders, representatives from prospective customer agencies, a combination of current and prospective customer agencies, or individual BPA holders. Some Federal Government Agencies and any approved State, Local and Tribal agencies may establish a central program management function. Such users may require their primary suppliers to participate in agency program review meetings on a periodic basis, at no additional cost to the Government.

  • END USER AGREEMENTS (“EUA H-GAC acknowledges that the END USER may choose to enter into an End User Agreement (“EUA) with the Contractor through this Agreement, and that the term of the EUA may exceed the term of the current H-GAC Agreement. H-GAC’s acknowledgement is not an endorsement or approval of the End User Agreement’s terms and conditions. Contractor agrees not to offer, agree to or accept from the END USER, any terms or conditions that conflict with those in Contractor’s Agreement with H-GAC. Contractor affirms that termination of its Agreement with H-GAC for any reason shall not result in the termination of any underlying EUA, which shall in each instance, continue pursuant to the EUA’s stated terms and duration. Pursuant to the terms of this Agreement, termination of this Agreement will disallow the Contractor from entering into any new EUA with END USERS. Applicable H-GAC order processing charges will be due and payable to H-GAC

  • Educational Program a. The educational program of the School (Section 4, Subsection 6 from the original contract and unchanged here) is as follows:

  • E-Verify Program Grantee certifies that it utilizes and will continue to utilize the U.S. Department of Homeland Security's E-Verify system to determine the eligibility of:

  • Provider Manual The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral processes, claims and encounter submission processes, continuity of care requirements, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs and Enrollee rights.

  • Minimum Customer Support Requirements for TIPS Sales Vendor shall provide timely and commercially reasonable support for TIPS Sales or as agreed to in the applicable Supplemental Agreement.

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