Medicaid Advantage Benefit Package definition

Medicaid Advantage Benefit Package means the services and benefits described in Appendix K-2 of this Agreement, plus the CMS approved Medicare supplemental premium for the Medicare Part C benefits described in Appendix K-l of this Agreement, if any, included in the Capitation Rate paid to the MCO by the State.
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Examples of Medicaid Advantage Benefit Package in a sentence

  • The services covered during the Guaranteed Eligibility period shall be those contained in the Medicaid Advantage Benefit Package, as specified in Appendix K-2, and free access to family planning and reproductive health services as set forth in Section 10.6 of this Agreement.

  • Instead, they should be taken into account by adjusting the number of awards included in the measurement of the liability arising from the transaction.

  • Providing information on: the providers from whom Enrollees may obtain Combined Medicare Advantage and Medicaid Advantage Benefit Package Services, any out-of-area coverage provided by the plan, and coverage of emergency services and urgently needed care.

  • The Contractor is responsible for payment of those services as covered by the Contractor’s Combined Medicare Advantage and Medicaid Advantage Benefit Package, even when provided by Non-Participating Providers.

  • Explaining the Contractor's rules for obtaining Medicare and Medicaid Advantage Benefit Package services and additional services available to the Enrollee through use of his/her Medicaid benefit card.

  • As of the Effective Date of Enrollment, and until the Effective Date of Disenrollment from the Contractor's product, the Contractor shall be responsible for the provision and cost of the Medicaid Advantage Benefit Package as described in Appendix K-2 of this Agreement for Enrollees whose names appear on the Prepaid Capitation Plan Roster.

  • Such consultation shall not be required in cases where it is clear that the Contractor was not a risk for the provision of the Medicaid Advantage Benefit Package for any portion of the retroactive period.

  • The documents and records kept by us or on our behalf, whether on paper, microfilm, by electronic recording or otherwise, will, in the absence of manifest error, constitute conclusive evidence of any facts or events relied upon by us in connection with any matter or dealing in relation to the Account.78.

  • Except as otherwise provided in applicable sections of this Agreement the Contractor shall provide the Medicaid Advantage Benefit Package to all Enrollees in the same manner, in accordance with the same standards, and with the same priority as Enrollees of the Contractor enrolled under any other contracts.

  • If the Contractor includes dental services in its Medicaid Advantage Benefit Package, the Contractor's dental network shall include geographically accessible general dentists sufficient to offer each Enrollee a choice of two (2) primary care dentists in their Service Area and to achieve a ratio of at least one (1) primary care dentist for each 2,000 Enrollees.

Related to Medicaid Advantage Benefit Package

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Medicare Advantage The Medicare managed care options that are authorized under Title XVIII as specified at Part C and 42 C.F.R. § 422.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Son or daughter of a covered servicemember means a covered servicemember's biological, adopted, or foster child, stepchild, legal ward, or a child for whom the covered servicemember stood in loco parentis, and who is of any age.

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Health and Welfare Benefits means any form of insurance or similar benefit programs, which may include but not be limited to, medical, hospitalization, surgical, prescription drug, dental, optical, psychiatric, life, or long-term disability.

  • Basic health benefit plan means any plan offered to an individual, a small group,

  • Death master file match means a search of the death master file that results in a match of the social security number or the name and date of birth of an insured, an annuity owner or a retained asset account holder.[PL 2017, c. 129, §1 (NEW).]

  • Medicaid program means the medical assistance

  • Medical benefit plan means a plan established and maintained by a carrier, a voluntary employees' beneficiary association described in section 501(c)(9) of the internal revenue code of 1986, 26 USC 501, or by 1 or more public employers, that provides for the payment of medical benefits, including, but not limited to, hospital and physician services, prescription drugs, and related benefits, for public employees or elected public officials. Medical benefit plan does not include benefits provided to individuals retired from a public employer or a public employer's contributions to a fund used for the sole purpose of funding health care benefits that are available to a public employee or an elected public official only upon retirement or separation from service.

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Medical Benefits Schedule means the Medicare Schedule of Benefits produced by the Department of Health to which all fees and benefits relate for inpatient hospital services.

  • Health Benefits means health maintenance organization, insured or self-funded medical, dental, vision, prescription drug and behavioral health benefits.

  • COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended.

  • Child welfare agency means a child-placing agency, child-caring institution or independent foster

  • Basic health plan means the plan described under chapter

  • Retiree means any person who has begun accruing a retirement

  • Pharmacy benefit manager means a person, business or other

  • Medical Benefits means the monthly fair market value of benefits provided to the Employee and the Employee’s dependents under the major medical, dental and vision benefit plans sponsored and maintained by the Company, at the level of coverage in effect for such persons immediately prior to the Employee’s termination of employment date. The “monthly fair market value” of such benefits shall be equal to the monthly cost as if such persons elected COBRA continuation coverage at such time at their own expense.

  • Parent of a covered servicemember means a covered servicemember’s biological, adoptive, step or foster father or mother, or any other individual who stood in loco parentis to the covered servicemember. This term does not include parents “in law.”

  • Non-Participating Clinical Social Worker means a Clinical Social Worker who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Participating Clinical Social Worker means a Clinical Social Worker who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Advanced emergency medical technician or “AEMT” means an individual who has successfully completed a course of study based on the United States Department of Transportation’s Advanced Emergency Medical Technician Instructional Guidelines (January 2009), has passed the psychomotor and cognitive examinations for the AEMT, and is currently certified by the department as an AEMT.