Benefit plan design definition

Benefit plan design means a specific health coverage product issued by a carrier to small employers, to trustees of associations that include small employers, or to individuals if the coverage is offered through employment or sponsored by an employer. It includes services covered and the levels of copayment and deductibles, and it may include the professional providers who are to provide those services and the sites where those services are to be provided. A benefit plan design may also be an integrated system for the financing and delivery of quality health care services which has significant incentives for the covered individuals to use the system.

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Benefit plan design means the terms, scope and conditions for Prescription Drug or device benefits under a Plan, including Formularies, exclusions, days or supply limitations, prior authorization or similar requirements, applicable Cost Share, benefit maximums and any other features or specifications as may be included in Plan documents, as communicated by the Customer to Aetna in accordance with any implementation procedures described herein. The Customer shall disclose to Plan Participants any and all matters relating to the Benefit Plan Design that are required by law to be disclosed, including information relating to the calculation of Cost Share or any other amounts that are payable by a Plan Participant in connection with the Benefit Plan Design.

Benefit plan design. Suite of drug benefits established by and/or for a Plan Sponsor, to contain but not limited to coverage inclusions/exclusions, limitations, pricing, DUR, DAW Codes, Network and formulary rules.

Examples of Benefit plan design in a sentence

• Should the health insurance provisions (Group Benefit) contained in this Agreement and/or Health and Welfare Trust (Group Benefit) plan design cause the Employer to become subject to a penalty, fine or other assessable payment under the Patient Protection and Affordable Care Act or any related law or regulation, the Union and the Employer will immediately meet to bargain over a solution that does not increase the total cost to the Employer.

• Benefit plan design, county funding rate and employee contributions for 2026 will be a subject of Total Compensation bargaining commencing January 1, 2025.

• Benefit plan design and options may be altered by PIC, following review and consideration of recommendations from the Labor Management Committee on health care.

More Definitions of Benefit plan design

Benefit plan design means a specific health coverage product offered for sale and includes services covered and the levels of copayments, deductibles, and annual out-of-pocket expenses, and may include the professional providers who are to provide those services and the sites where those services are to be provided. A benefit plan design may also be an integrated system for the financing and delivery of quality health care services that has significant incentives for the covered individuals to use the system.

Benefit plan design or “BPD” means a description of the essential elements of the Pharmacy Benefit Plan, provided by Participating Program to Contractor for the initial program Implementation and ongoing program management.