Medical and Mental Health Benefits Administrator definition

Medical and Mental Health Benefits Administrator means the entity(ies) that has contracted with Portico Benefit Services to administer Medical and Mental Health Benefits in one or more identified geographic areas. Pursuant to such contract, the Administrator shall, within each geographic area:
Sample 1

Examples of Medical and Mental Health Benefits Administrator in a sentence

  • The Medical and Mental Health Benefits Administrator administers precertification and Medical Necessity reviews.

  • A Hospital or alternative specialized treatment Facility is a hospital or facility that qualifies for reimbursement and meets the standards and requirements of the Medical and Mental Health Benefits Administrator including review requirements in Section 12.14.

  • Charges for services or supplies that are experimental or investigational, as determined by the Medical and Mental Health Benefits Administrator.

  • Costs incurred by a Member for services in a Hospital or Facility which does not meet the requirements established for a Hospital or Facility as determined by the Medical and Mental Health Benefits Administrator.

  • Medically Necessary inpatient services provided to a Member in a qualified skilled nursing facility for up to ninety (90) days of continuous care after Medicare became primary health coverage for the Member, if such care began and was authorized by the Medical and Mental Health Benefits Administrator while the Member was covered under ELCA-Primary Benefits Coverage and continued without interruption after the date when Medicare became primary coverage for the Member.

  • Transitional Care is Eligible Medical and Mental Health care that began prior to the Transition Date and is authorized for a specified Transitional Time Period by the Medical and Mental Health Benefits Administrator.

  • The following analysis represents the Company’s best estimates of the effect on net assets and profit due to a reasonably possible change in the market price of the Company’s financial instruments, with all other variables held constant.

  • In addition to the reimbursement of Eligible Mental Health Expenses, the Plan will pay for Eligible Employee Assistance Program (EAP) services, including counseling, support and referral services, that have been pre-approved by the EAP administrator contracted to provide EAP services by the Medical and Mental Health Benefits Administrator.

  • The Medical and Mental Health Benefits Administrator monitors claims data for Members.

  • The term hybrid transaction hasthe meaning provided in § 1.267A– 2(a)(2).

Related to Medical and Mental Health Benefits Administrator

  • Pharmacy benefits manager means a person that performs pharmacy benefits management.

  • Pharmacy benefits management means the administration or management of prescription drug

  • Mental health provider means a health care provider or a health care facility authorized by state law to provide mental health services.

  • Essential Health Benefits means, under section 1302(b) of the Patient Protection and Affordable Care Act, those health benefits to include at least the following general categories and the items and services covered within the categories: ambulatory patient services; Emergency Services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

  • Designated mental health professional means a mental health

  • Claims Administration means the processing of claims made under the Shared Policies, including, without limitation, the reporting of claims to the insurance carriers and the management of the defense of claims.

  • Mental health services means interventions designed to provide the maximum reduction of mental disability and restoration or maintenance of functioning consistent with the requirements for learning, development and enhanced self-sufficiency. Services shall include:

  • Mental health services provider means an individual, licensed or unlicensed, who performs or purports to perform mental health services, including a:

  • Pharmacy benefit manager means a person, business or other

  • Basic health plan services means that schedule of covered

  • Mental Health Worker means an individual that assists in planning, developing and evaluating mental health services for Clients; provides liaison between Clients and service providers; and has obtained a Bachelor's degree in a behavioral science field such as psychology, counseling, or social work, or has two years of experience providing client related services to Clients experiencing mental health, drug abuse or alcohol disorders. Education in a behavioral science field such as psychology, counseling, or social work may be substituted for up to one year of the experience requirement.

  • Health benefits plan means a benefits plan which pays or

  • Mental health professional means a psychiatrist,

  • Department of Health and Human Services means the Department of Health and Human Services

  • Mental health service provider means a public or private

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

  • Medical Benefits means medical, optical, or dental benefits, including, but not limited to, hospital and physician services, prescription drugs, and related benefits.

  • Basic health plan means the plan described under chapter

  • Participating Retail Health Clinic means a Retail Health Clinic which 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.

  • Non-Administrator Hospital means a Hospital that does not meet the definition of an Administrator Hospital.

  • 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.

  • Medical Review Officer (MRO means a licensed M.D. or D.O. with knowledge of drug abuse disorders, employed or used by the City to review drug results in accordance with this procedure.

  • 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.

  • Gap medical benefits means the benefits (if any) payable in respect of medical expenses that are less than, greater than or equal to the schedule fee, provided always that the medical expenses relate to a professional service that:

  • Claims Administrator means the firm proposed by Class Counsel and appointed by the Courts to administer the Settlement Amount in accordance with the provisions of this Settlement Agreement and the Distribution Protocol, and any employees of such firm.

  • Local Health Board (“Bwrdd Iechyd Lleol”) means a Local Health Board established under section 11 of the National Health Service (Wales) Act 2006 (c.42);