Verification of Benefits Sample Clauses

Verification of Benefits. Verification of Benefits is available for Members or authorized healthcare Providers on behalf of Members. You may call Customer Service with a medical benefits inquiry or Verification of Benefits during normal business hours (8:00 a.m. to 5:00 p.m. eastern time). Please remember that a benefits inquiry or Verification of Benefits is NOT a verification of coverage of a specific medical procedure.  Verification of Benefits is NOT a guarantee of payment.  If the verified service requires Prior Authorization, please call 0-000-000-0000. Prior Authorization – In-Network (also known as Pre-Certification) For Prior Authorization call 0-000-000-0000.  Required by your Physician or facility for ALL in-patient hospital admissions that are In- Network.  Please notify us by the next business day of an emergency or maternity admission;  Non-Urgent Care pre- certifications can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time).  Emergency services do NOT require Prior Authorization. Prior Authorization – Out-of-Network (also known as Pre-Certification) For Prior Authorization call 0-000-000-0000.  Required by YOU for ALL in-patient hospital admissions that are Outdo--Network.  YOU are responsible for notifying us within 1-business day of an emergency or maternity admission, or your claim may be denied.  Non-Urgent Care Prior Authorizations can be requested during normal business hours (8:30 a.m. – 5:00 p.m. eastern time).  Emergency services do NOT require Prior Authorization. Prior Authorization is a guarantee of payment f o r C o v e r e d S e r v i c e s ; as described in this section (and Alliant will pay up to the reimbursement level of this Contract when the Covered Services are performed within the time limits assigned through Coverage Certification) except for the following situations:  The Member is no longer covered under this Contract at the time the services are received;  The benefits under this Contract have been exhausted (examples of this include day limits);  In cases of fraud or misrepresentation. Prior Authorization approvals apply only to services which have been specified in the Prior Authorization and/or prior authorization list available on our website under provider resources. A Prior Authorization approval does not apply to any other services; other than the specific service being pre-certified. Payment or authorization of such a service does not require or apply to payment of claims at a later date rega...
Sample 1See All (4)
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Verification of Benefits. PROVIDER understands and acknowledges that any verification of benefits which PROVIDER may receive pursuant to access of myBlue, does not represent a guarantee of payment of such benefits by BCBSMS. Benefits are subject to the terms and conditions of the Benefit Plan.
Sample 1
Verification of Benefits. PHARMACY understands and acknowledges that any verification of benefits which PHARMACY may receive pursuant to access of myBlue, does not represent a guarantee of payment of such benefits by BCBSMS. Benefits are subject to the terms and conditions of the Benefit Plan.
Sample 1
Verification of Benefits. When We provide information about which health care services are covered under Your Plan that information is referred to as verification of benefits. When You or Your Provider call Our Customer Service Department at 000-000-0000 during regular business hours to request verification of benefits, a Health Plan representative will be immediately available to provide assistance. If the health care services are verified as a covered benefit, the Customer Service representative will advise whether Prior Authorization is required. Please be aware that verification of benefits is not a guarantee of payment for services. SECTION 2
Sample 1

Related to Verification of Benefits

  • Duplication of Benefits Grantee shall not carry out any of the activities under this Agreement in a manner that results in a prohibited duplication of benefits as defined by Section 312 of the Xxxxxx X. Xxxxxxxx Disaster Relief and Emergency Assistance Act (42 U.S.C. 5155) and in accordance with Section 1210 of the Disaster Recovery Reform Act of 2018 (division D of Public Law 115-254; 132 Stat. 3442), which amended section 312 of the Xxxxxx X. Xxxxxxxx Disaster Relief and Emergency Assistance Act (42 U.S.C. 5155). In consideration of Grantee’s receipt or the commitment of CRF funds by Florida Housing, Grantee hereby assigns to Florida Housing all of Grantee’s future rights to reimbursement and all payments received from any grant, subsidized loan or any other reimbursement or relief program related to the basis of the calculation of the portion of the funds committed to the Grantee under this Agreement and determined to be a Duplication of Benefits (DOB). Any such funds received by the Grantee shall be referred to herein as “additional funds.” Grantee agrees to immediately notify Florida Housing of the source and receipt of additional funds received by the Grantee that are determined to be a DOB. Grantee agrees to reimburse Florida Housing for any additional funds received by Grantee if such additional funds are determined to be a DOB by Florida Housing, the Federal awarding agency or an auditing agency.

  • Coordination of Benefits The coordination of benefits (COB) provision applies when a Member has health care coverage under more than one plan. Plan is defined below. The order of benefit determination rules govern the order in which each plan will pay a claim for benefits. The plan that pays first is called the primary plan. The primary plan must pay benefits according to its policy terms without regard to the possibility that another plan may cover some expenses. The plan that pays after the primary plan is the secondary plan. In no event will a secondary plan be required to pay an amount in excess of its maximum benefit plus accrued savings. If the Member is covered by more than one health benefit plan, and the Member does not know which is the primary plan, the Member or the Member’s provider should contact any one of the health plans to verify which plan is primary. The health plan the Member contacts is responsible for working with the other plan to determine which is primary and will let the Member know within 30 calendar days. All health plans have timely claim filing requirements. If the Member or the Member’s provider fails to submit the Member’s claim to a secondary health plan within that plan’s claim filing time limit, the plan can deny the claim. If the Member experiences delays in the processing of the claim by the primary health plan, the Member or the Member’s provider will need to submit the claim to the secondary health plan within its claim filing time limit to prevent a denial of the claim. If the Member is covered by more than one health benefit plan, the Member or the Member’s provider should file all the Member’s claims with each plan at the same time. If Medicare is the Member’s primary plan, Medicare may submit the Member’s claims to the Member’s secondary carrier.

  • Calculation of Benefits Immediately following delivery of any Notice of Termination, the Company shall notify the Executive of the aggregate present value of all termination benefits to which he would be entitled under this Agreement and any other plan, program or arrangement as of the projected Date of Termination, together with the projected maximum payments, determined as of such projected Date of Termination that could be paid without the Executive being subject to the Excise Tax.

  • Payment of Benefits Any amounts due under this Agreement shall be paid in one (1) lump sum payment as soon as administratively practicable following the later of: (i) Xx. Xxxxxx'x Termination Date, or (ii) upon Xx. Xxxxxx'x tender of an effective Waiver and Release to the Company in the form of Exhibit A attached hereto and the expiration of any applicable revocation period for such waiver. In the event of a dispute with respect to liability or amount of any benefit due hereunder, an effective Waiver and Release shall be tendered at the time of final resolution of any such dispute when payment is tendered by the Company.

  • Termination of Benefits Except as provided in Section 2 above or as may be required by law, Executive’s participation in all employee benefit (pension and welfare) and compensation plans of the Company shall cease as of the Termination Date. Nothing contained herein shall limit or otherwise impair Executive’s right to receive pension or similar benefit payments that are vested as of the Termination Date under any applicable tax-qualified pension or other plans, pursuant to the terms of the applicable plan.

  • Retention of Benefits Union leave under the following four (4) sections will be unpaid. The Employer will maintain regular pay and xxxx the Union for the costs of the employee’s salary and benefits. If the Union member is part-time or casual, and the leave is greater than their normal work hours, the Employer will pay the employee for the full length of the leave requested by the Union. The Employer will xxxx the Union for these days as noted above. The Union will pay these invoices within twenty-eight (28) days. Union leave is not unpaid leave for the purposes of Article 22.02 [i.e. such leave will not affect the employee’s benefits, seniority or increment anniversary date].

  • Limitation of Benefits (a) Anything in this Agreement to the contrary notwithstanding, in the event it shall be determined that any benefit, payment or distribution by the Company or any of its direct and/or indirect subsidiaries to or for the benefit of Employee (whether paid or payable or distributed or distributable pursuant to the terms of this Agreement or otherwise, but determined without regard to any additional payments required under this Section 18) (such benefits, payments or distributions are hereinafter referred to as “Payments”) would, if paid, be subject to the excise tax imposed by Section 4999 of the Code (the “Excise Tax”), then, prior to the making of any Payments to Employee, a calculation shall be made comparing (i) the net after-tax benefit to Employee of the Payments after payment by Employee of the Excise Tax, to (ii) the net after-tax benefit to Employee if the Payments had been limited to the extent necessary to avoid being subject to the Excise Tax. If the amount calculated under (i) above is less than the amount calculated under (ii) above, then the Payments shall be limited to the extent necessary to avoid being subject to the Excise Tax (the “Reduced Amount”). The reduction of the Payments due hereunder, if applicable, shall be made by first reducing cash Payments and then, to the extent necessary, reducing those Payments having the next highest ratio of Parachute Value to actual present value of such Payments as of the date of the change of control, as determined by the Determination Firm (as defined in Section 18(b) below). For purposes of this Section 18, present value shall be determined in accordance with Section 280G(d)(4) of the Code. For purposes of this Section 18, the “Parachute Value” of a Payment means the present value as of the date of the change of control of the portion of such Payment that constitutes a “parachute payment” under Section 280G(b)(2) of the Code, as determined by the Determination Firm for purposes of determining whether and to what extent the Excise Tax will apply to such Payment.

  • Description of Benefits The benefits available under this Plan will be as defined in Item F(2) of the Adoption Agreement.

  • Duration of Benefits Eligibility for Income Protection benefits will cease upon the earliest of the following dates:

  • Cessation of Benefits An employee shall cease to be eligible for benefits of this Plan at the earliest of the following dates:

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