Full Benefit Dual Eligible definition

Full Benefit Dual Eligible means individuals enrolled in Medicare and eligible for full Medicaid benefits, not limited to covering costs, such as Medicare premiums.
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Full Benefit Dual Eligible means an individual who is eligible for both Medicare and Medicaid.
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Full Benefit Dual Eligible. An individual who is eligible for a full benefit Medicaid plan and and Medicare. Full benefit Medicaid programs in Wisconsin include, BadgerCare Plus, SSI Medicaid, SSI- related Medicaid, Medicaid Purchase Plan (XXXX), Wisconsin Well Woman Medicaid, Institutional Medicaid, Family Care, Family Care Partnership, Include, Respect, I Self-Direct (IRIS), and Children’s Long-Term Support Waiver Program (CLTS).
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Examples of Full Benefit Dual Eligible in a sentence

  • An individual who does not meet the income or resource criteria for Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB), but is eligible for Medicaid either categorically or through optional coverage groups based on Medically Needy status, special income levels for institutionalized individuals, or home and community-based waivers is considered Full Benefit Dual Eligible (FBDE).

  • For an Other Full Benefit Dual Eligible Member, AHCCCS does not provide payment for either Medicare Part A or Part B premiums.

  • For an Other Full Benefit Dual Eligible Member, AHCCCS payments of Medicare coinsurance amounts and Medicare deductibles for Medicare covered services are limited.

  • On behalf of currently enrolled AHCCCS categorically eligible members who receive full medical assistance benefits, and who become newly Medicare eligible either by age or disability, and that such Medicare eligibility results in Full Benefit Dual Eligible status for such members , MAO shall perform the default enrollment process as provided by 42 CFR 422.66 and 422.68.

  • Eligible beneficiaries are also eligible for full Medicaid benefits.§ Full Benefit Dual Eligible (FBDE): An individual who is not QMB or SLMB, but is eligible for full Medicaid benefits either categorically or through optional coverage groups.

  • MAO shall have access to real-time and daily Medicaid eligibility data for Full Benefit Dual Eligible Members enrolled in its integrated companion ACC, ALTCS E-PD, ALTCS DD, or ACC-RBHA health plan.

  • XXX shall accurately verify both potential and enrolled Full Benefit Dual Eligible Members’ Medicaid program eligibility status.

  • Section 1902(n)(3)(B) of the Social Security Act prohibits a Medicare provider from balance billing a QMB Plus Full Benefit Dual Eligible Member for Medicare cost sharing amounts, including deductibles, coinsurance, and copayments.

  • These individuals are considered to be Full Benefit Dual Eligible Members, and include Qualified Medicare Beneficiary Plus (QMB Plus), Specified Low-Income Medicare Beneficiary Plus (SLMB Plus) and Other Full Benefit Dual Eligible (Other FBDE) populations.

  • AHCCCS will continue to work with stakeholders to establish practices which improve alignment for Full Benefit Dual Eligible Members.


More Definitions of Full Benefit Dual Eligible

Full Benefit Dual Eligible or "FBDE" is an individual who is eligible for full Medicaid benefits under the Medicaid State Plan because the individual falls within a federal mandatory coverage group or an optional coverage group (such as medically needy) but who does not meet the income or resource criteria for QMB or SLMB. Under the Medicaid State Plan, FBDEs are eligible for some financial assistance from the Agency in connection with Medicare Part A premiums, and in some cases Medicare Part B premiums. Medicare cost-sharing obligations may effectively be covered by the State Medicaid benefit, but certain conditions must be met, including 1) the service is also covered by Medicaid, 2) the provider is also a Medicaid provider, and 3) the Medicaid fee schedule amount is greater than the Medicare amount paid.
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Related to Full Benefit Dual Eligible

  • Retirement Eligible means that the Participant has either attained age 55 and completed ten (10) years of Service as an Employee or attained age 60 and completed five (5) years of Service as an Employee.

  • Retirement Eligibility means attainment of age 60 and completion of at least five (5) years of continuous service with the Company.

  • Accrued Benefit means the amount standing in a Participant's Account(s) as of any date derived from both Employer contributions and Employee contributions, if any.

  • Social Security Retirement Age means the age used as the retirement age under Section 216(l) of the Social Security Act, applied without regard to the age increase factor and as if the early retirement age under Section 216(l)(2) of such Act were 62.

  • Disability benefit recipient means a member who is receiving a disability benefit.

  • Disability Retirement Date means the first day of the month following the last day of paid employment;

  • Net Benefits Test means a calculation to determine whether the benefits of a reduction in price resulting from the dispatch of Economic Load Response exceeds the cost to other loads resulting from the billing unit effects of the load reduction, as specified in Operating Agreement, Schedule 1, section 3.3A.4 and the parallel provisions of Tariff, Attachment K-Appendix, section 3.3A.4.

  • Normal Retirement Benefit means an annual benefit equal to One Hundred Fifty Thousand Dollars and No/100 ($150,000.00) per year, payable in accordance with the terms of this Agreement. Beginning on the thirteenth month that the Normal Retirement Benefit is paid, and continuing thereafter until paid in full, the Normal Retirement Benefit shall be increased annually by three percent (3%) from the previous year’s Normal Retirement Benefit amount to account for cost of living increases.

  • Pre-Retirement Survivor Benefit means the benefit set forth in Article 6.

  • Eligible Earnings means the Grantee's base salary (prior to any deferrals under a cash or deferred compensation plan sponsored by the Corporation or an Affiliate) paid during the Plan Year. From time to time the Plan Administrator may, in its sole discretion, establish rules for determining the amounts of Eligible Earnings for employees who become Grantees other than on the first day of a Plan Year as well as any reduction of Eligible Earnings as a result of paid leave of absences.

  • Disability retirement for plan 1 members, means the period

  • Annual Benefit Limit means the maximum amount of benefits paid by the Company to the Policy Holder in a Policy Year irrespective of whether any limits of any benefit items stated in the Benefit Schedule have been reached. The Annual Benefit Limit is counted afresh in a new Policy Year.

  • Annual Benefit means an annual sum of fifty thousand dollars ($50,000) multiplied by the Applicable Percentage (defined below) and then reduced to the extent required: (i) under the other provisions of this Agreement; (ii) by reason of the lawful order of any regulatory agency or body having jurisdiction over the Employer; and (iii) in order for the Employer to properly comply with any and all applicable state and federal laws, including, but not limited to, income, employment and disability income tax laws (eg., FICA, FUTA, SDI).

  • Supplemental Retirement Income Benefit means an annual amount (before taking into account federal and state income taxes), payable in monthly installments throughout the Payout Period. Such benefit is projected pursuant to the Agreement for the purpose of determining the Contributions to be made to the Retirement Income Trust Fund (or Phantom Contributions to be recorded in the Accrued Benefit Account). The annual Contributions and Phantom Contributions have been actuarially determined, using the assumptions set forth in Exhibit A, in order to fund for the projected Supplemental Retirement Income Benefit. The Supplemental Retirement Income Benefit for which Contributions (or Phantom Contributions) are being made (or recorded) is set forth in Exhibit A.

  • Plan Benefit means the benefit payable to a Participant as calculated in Article V.

  • Termination Benefit means the benefit set forth in Article 7.

  • Regular benefits ’ means benefits payable to an individual under this act or under any other state law, including benefits payable to federal civilian employees and to ex-servicemen pursuant to 5 U.S.C. chapter 85, other than extended benefits.

  • Public benefit means making capital available, or facilitating the availability of capital, to businesses in this state that have 750 or fewer employees, the intent of which is to create or retain employment opportunities for residents of this state, stabilize or increase the tax base of this state, or support the redevelopment of facilities for use by small businesses.

  • Lifetime Benefit Limit means the maximum amount of benefits paid by the Company to the Policy Holder cumulatively since the inception of these Terms and Benefits, irrespective whether any limits of any benefit items stated in the Benefit Schedule have been reached or whether the Annual Benefit Limit in a Policy Year has been reached.

  • Individual retirement account means a trust, custodial arrangement, or annuity under Section 408(a) or (b), Internal Revenue Code of 1954 (26 U.S.C. Section 408 (1986)).

  • Small employer carrier means any carrier that offers health benefit plans covering eligible employees of one or more small employers in this state.

  • Change in Control Benefit means the benefit described in Section 2.4.

  • Eligible veteran means an individual who is certified by the Wisconsin Department of Veterans Affairs as meeting all of the following conditions:

  • Disability Benefit means the benefit set forth in Article 8.

  • Qualifying Retirement means the Employee’s voluntary termination of employment after the Employee has (i) attained (X) age sixty-five (65), (Y) age fifty-five (55) with ten (10) Years of Service as a full-time employee of the Partnership or any of its Affiliates, or (Z) an age which, when added to such Years of Service of the Employee equals at least seventy-five (75), and (ii) previously delivered a written notice of retirement to the Partnership and on the date of retirement the Employee has satisfied the minimum applicable advance written notice requirement set forth below: Age at Voluntary Termination Number of Years of Advance Notice 58 or younger 59 60 or older 3 years 2 years 1 year By way of illustration, and without limiting the foregoing, if (i) the Employee is eligible to retire at age fifty-nine (59) after ten (10) Years of Service, (ii) the Employee gives two (2) years notice at age fifty-eight (58) that the Employee intends to retire at age sixty (60), and (iii) the Employee later terminates employment at age fifty-nine (59), then the Employee’s retirement at age fifty-nine (59) would not constitute a Qualifying Retirement. However, if (i) the Employee is eligible to retire at age fifty-nine (59) after ten (10) Years of Service, (ii) the Employee gives two (2) years notice at age fifty-eight (58) that the Employee intends to retire at age sixty (60), and (iii) the Employee terminates employment upon reaching age sixty (60), then the Employee’s retirement at age sixty (60) would constitute a Qualifying Retirement.

  • Eligible Participant means an employee, officer, consultant or director of the Company or any Affiliate.