One Year Limit to Assert Claim Sample Clauses

One Year Limit to Assert Claim. (A) The STATE shall not assert any claim for or seek the reimbursement of or make any adjustment for any alleged overpayment made by the STATE to the MCO under this section more than one year after the date such payment was actually received by the MCO from the STATE. This one year limitation, along with the notice requirement described in section 4.17.5, does not apply to duplicate payments made because of multiple identification numbers for the same Enrollee, payments for full months for a Medical Assistance Enrollee who is incarcerated in a facility, and payments for full months after the death of the Enrollee.
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One Year Limit to Assert Claim. (1) The STATE shall not assert any claim for, seek the reimbursement of, or make any adjustment for any alleged overpayment made by the STATE to the MCO under section 4.1 more than one (1) year after the date such payment was actually received by the MCO from the STATE. This one year limitation, along with the notice requirement described in section 4.13.3.2(4), does not apply to duplicate payments made because of multiple identification numbers for the same Enrollee, payments for full months for an Enrollee while Incarcerated, and payments for full months after the death of the Enrollee and in the event that CMS or the state or federal Office of the Inspector General requires the STATE to recover payments.
One Year Limit to Assert Claim. A. The STATE shall not assert any claim for or seek the payment of or make any adjustment for any alleged overpayment made by the STATE to the HEALTH PLAN under Section 4.6. more than one year after the date such payment was actually received by the HEALTH PLAN from the STATE, except for duplicate payments because of multiple identification numbers for the same Enrollee, and payments for months after the death of the Enrollee.

Related to One Year Limit to Assert Claim

  • Payment in the Event Losses Fail to Reach Expected Level On the date that is 45 days following the last day (such day, the “True-Up Measurement Date”) of the Final Shared Loss Month, or upon the final disposition of all Shared Loss Assets under this Single Family Shared-Loss Agreement at any time after the termination of the Commercial Shared-Loss Agreement, the Assuming Institution shall pay to the Receiver fifty percent (50%) of the excess, if any, of (i) twenty percent (20%) of the Intrinsic Loss Estimate less (ii) the sum of (A) twenty-five percent (25%) of the asset premium (discount) plus (B) twenty-five percent (25%) of the Cumulative Shared-Loss Payments plus (C) the Cumulative Servicing Amount. The Assuming Institution shall deliver to the Receiver not later than 30 days following the True-Up Measurement Date, a schedule, signed by an officer of the Assuming Institution, setting forth in reasonable detail the calculation of the Cumulative Shared-Loss Payments and the Cumulative Servicing Amount.

  • Dollar Limits Per Service Agreement Cost to diagnose, repair and/or replace - Geothermal and water source systems $1,500 Water cooled air conditioners, high velocity and hydronic systems $1,500 Concrete encased or concealed ductwork $500 Refrigerant lines $500 Appliances l Standard/Seller Coverage S Supreme Coverage l S Appliance color matchSM l S Built-in microwave l S Dishwasher l S Garbage disposal l S Range, oven, cooktop and vent hood l S Refrigerator - INCLUDING ICE MAKER! S Washer and dryer S Range, oven, cooktop, hood: handles, hinges, clocks, rotisseries, racks, knobs and dials, interior lining, glass/ceramic cooktops, self cleaning mechanisms and latch assemblies S Kitchen Refrigerator: handles, hinges, ice crusher, beverage dispenser and respective equipment S Built-in microwave: handles, hinges, interior lining, clocks and shelves, turntable platforms and rollers S Dishwasher: handles, hinges, racks, baskets, rollers, tub and interior lining, springs, latch assemblies and soap dispensers S Permits up to $250 per Service Agreement S Modifications up to $250 per Service Agreement S Haul away/disposal fees S Items under manufacturer’s warranty Excluded Items: ✖ Appliances not located in the primary kitchen (except washer and dryer) and duplicate appliances, unless additional refrigerator option(s) are purchased. ✖ Meat probe assemblies, door glass, sensi-heat burners will only be replaced with standard burners for range, oven, cooktop. ✖ Multimedia center including technology convenience items like LCD screens, Wi-Fi and cameras. ✖ Racks, hinges, shelves, interior thermal shells, food spoilage and freezers which are not an integral part of the kitchen refrigerator. ✖ Door glass, portable or counter top units, trim kits, meat probe assemblies, rotisseries for built-in microwave. ✖ Damage to clothing, plastic mini-tub, soap dispensers, filter screens, knobs, dials, hinges and lint screen for washer or dryer. ✖ Gas supply line to stove.

  • Indemnity Limitation for TIPS Sales Texas and other jurisdictions restrict the ability of governmental entities to indemnify others. Vendor agrees that if any "Indemnity" provision which requires the TIPS Member to indemnify Vendor is included in any TIPS sales agreement/contract between Vendor and a TIPS Member, that clause must either be stricken or qualified by including that such indemnity is only permitted, "to the extent permitted by the laws and constitution of [TIPS Member's State]” unless the TIPS Member expressly agrees otherwise. Any TIPS Sale Supplemental Agreement containing an "Indemnity" clause that conflicts with these terms is rendered void and unenforceable.

  • Contribution Formula - Basic Life Coverage For employee basic life coverage and accidental death and dismemberment coverage, the Employer contributes one-hundred (100) percent of the cost.

  • Benefit Waiting Period Allowance (a) An employee who qualifies for and takes leave pursuant to 21.1 or 21.2 and is required by Employment Insurance to serve a one-week waiting period for Employment Insurance Maternity/Parental benefits, shall be paid a leave allowance equivalent to one week at 85% of the employee's basic pay.

  • Requiring Minimum Compensation for Covered Employees a. Contractor agrees to comply fully with and be bound by all of the provisions of the Minimum Compensation Ordinance (MCO), as set forth in San Francisco Administrative Code Chapter 12P (Chapter 12P), including the remedies provided, and implementing guidelines and rules. The provisions of Sections 12P.5 and 12P.5.1 of Chapter 12P are incorporated herein by reference and made a part of this Agreement as though fully set forth. The text of the MCO is available on the web at xxx.xxxxx.xxx/xxxx/xxx. A partial listing of some of Contractor's obligations under the MCO is set forth in this Section. Contractor is required to comply with all the provisions of the MCO, irrespective of the listing of obligations in this Section.

  • Liability Calculation Method Per Claim Unless subject to a fixed dollar copayment, the calculation of Member liability on claims for Out-of-Area Covered Health Care Services processed through the BlueCard Program will be based on the lower of the provider’s billed charges or the negotiated price made available to Blue Shield by the Host Blue. Host Blues determine a negotiated price, which is reflected in the terms of each Host Blue’s health care provider contracts. The negotiated price made available to Blue Shield by the Host Blue may be represented by one of the following:

  • Can I Roll Over or Transfer Amounts from Other IRAs or Employer Plans If properly executed, you are allowed to roll over a distribution from one Traditional IRA to another without tax penalty. Rollovers between Traditional IRAs may be made once every 12 months and must be accomplished within 60 days after the distribution. Beginning in 2015, just one 60 day rollover is allowed in any 12 month period, inclusive of all Traditional, Xxxx, SEP, and SIMPLE IRAs owned. Under certain conditions, you may roll over (tax-free) all or a portion of a distribution received from a qualified plan or tax-sheltered annuity in which you participate or in which your deceased spouse participated. In addition, you may also make a rollover contribution to your Traditional IRA from a qualified deferred compensation arrangement. Amounts from a Xxxx XXX may not be rolled over into a Traditional IRA. If you have a 401(k), Xxxx 401(k) or Xxxx 403(b) and you wish to rollover the assets into an IRA you must roll any designated Xxxx assets, or after tax assets, to a Xxxx XXX and roll the remaining plan assets to a Traditional IRA. In the event of your death, the designated beneficiary of your 401(k) Plan may have the opportunity to rollover proceeds from that Plan into a Beneficiary IRA account. In general, strict limitations apply to rollovers, and you should seek competent advice in order to comply with all of the rules governing rollovers. Most distributions from qualified retirement plans will be subject to a 20% withholding requirement. The 20% withholding can be avoided by electing a “direct rollover” of the distribution to a Traditional IRA or to certain other types of retirement plans. You should receive more information regarding these withholding rules and whether your distribution can be transferred to a Traditional IRA from the plan administrator prior to receiving your distribution.

  • Benefit Level The primary care clinics available through each plan administrator are assigned a Benefit Level. The Benefit Levels are outlined in the benefit chart below. Primary care clinics may be in different Benefit Levels for different plan administrators. Family members may be enrolled in clinics that are in different Benefits Levels. Employees and their dependents may change to clinics in different Benefit Levels during the annual open enrollment. Employees and their dependents may also elect to move to a clinic in a different Benefit Level within the same plan administrator up to two (2) additional times during the plan year. Unless the individual has a referral from his/her primary care clinic, there are no benefits for services received from providers in Benefit Levels that are different from that of the primary care clinic in which the individual has enrolled.

  • Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions (a) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

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