Special Medicaid Programs Sample Clauses

Special Medicaid Programs to uninsured children below the age of 19 with family incomes above 133 percent and up to and including 150 per cent of the federal poverty level. In addition to covered managed care services, eligibles under this program may access certain other services which are paid fee-for-service and not covered under this contract. NJ FAMILYCARE PLAN C--means the State-operated program which provides comprehensive managed care coverage, including all benefits provided through the New Jersey Care... Special Medicaid Programs, to uninsured children below the age of 19 with family incomes above 150 percent and up to and including 200 percent of the federal poverty level. Eligibles are required to participate in cost-sharing in the form of monthly premiums and a personal contribution to care for most services. In addition to covered managed care services, eligibles under this program may access certain other services which are paid fee-for-service and not covered under this contract. NJ FAMILYCARE PLAN D--means the State-operated program which provides managed care coverage to uninsured: o Adults and couples without dependent children under the age of 19 with family incomes above 50% and up to and including 100 percent of the federal poverty level; o Adults and couples without dependent children under the age of 23 years with family incomes up to and including 250% of the federal poverty level; o Parents/caretakers with children below the age of 19 who do not qualify for AFDC Medicaid with family incomes up to and including 200 percent of the federal poverty level; o Parents/caretakers with children below the age of 23 years and children from the age of 19 through 22 years who a re full time students who do not qualify for AFDC Medicaid with family incomes up to and including 250% of the federal poverty level; and o Children below the age of 19 with family incomes between 201 percent and up to and including 350 percent of the federal poverty level. Eligibles with incomes above 150 percent of the federal poverty level are required to participate in cost sharing in the form of monthly premiums and copayments for most services. These groups are identified by Program Status Codes (PSCs) on the eligibility system as indicated below. For clarity, the codes related to Plan D non-cost sharing groups are also listed. Cost Sharing No Cost Sharing ------------ --------------- 493 497 494 763 495 300 498 700 301 701 In addition to covered managed care services, eligibles under thes...
Sample 1
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Special Medicaid Programs. Pregnant women up to 200 percent of the federal poverty level; - AFDC eligibles with incomes up to and including 133 percent of the federal poverty level; - Parents/caretaker relatives with children below the age of 19 years who do not qualify for AFDC Medicaid and have family incomes up to and including 133 percent of the federal poverty level; - Uninsured single adults/couples without dependent children with family incomes up to and including 50 percent of the federal poverty level; and
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Special Medicaid Programs to uninsured children below the age of 19 with family incomes above 133 percent and up to and including 150 percent of the federal poverty level. In addition to covered managed care services, eligibles under this program may access certain other services which are paid fee-for-service and not covered under this contract.
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Special Medicaid Programs o Pregnant women up to 200 percent of the federal poverty level; o AFDC eligibles with incomes up to and including 133 percent of the federal poverty level; o Parents/caretaker relatives with children below the age of 19 years who do not qualify for AFDC Medicaid and have family incomes up to and including 133 percent of the federal poverty level; o Uninsured single adults/couples without dependent children with family incomes up to and including 50 percent of the federal poverty level; and o General Assistance eligibles. In addition to covered managed care services, eligibles under this program may access certain other services which are paid fee-for-service and not covered under this contract.
Sample 1
Special Medicaid Programs to uninsured children below the age of 19 with family incomes above 150 percent and up to and including 200 percent of the federal poverty level. Eligibles are required to participate in cost-sharing in the form of monthly premiums and a personal contribution to care for most services. Exception - Both Eskimos and Native American Indians under the age of 19 years old, identified by Race Code 3, shall not participate in cost sharing, and shall not be required to pay a personal contribution to care. In addition to covered managed care services, eligibles under this program may access certain other services which are paid fee-for-service and not covered under this contract. NJ FAMILYCARE PLAN D--means the State-operated program which provides managed care coverage to uninsured: - Parents/caretakers -with children below the age of 19 who do not qualify for AFDC Medicaid with family incomes up to and including 133 percent of the federal poverty level; AND - Children below the age of 19 with family incomes between 201 percent and up to and including 350 percent of the federal poverty level. Eligibles with incomes above 150 percent of the federal poverty level are required to participate in cost sharing in the form of monthly premiums and copayments for most services with the exception of both Eskimos and Native American Indians under the age of 19 years. These groups are identified by Program Status Codes (PSCs) or Race Code on the eligibility system as indicated below. For clarity, the Program Status Codes or Race Code, in the case of Eskimos and Native American Indians under the age of 19 years, related to Plan D non-cost sharing groups are also listed. PSC PSC Race Code Cost Sharing No Cost Sharing No Cost Sharing ------------ --------------- --------------- 493 380 3 494 495 In addition to covered managed care services, eligibles under these programs may access certain services which are paid fee-for-service and not covered under this contract. XX FAMILYCARE PLAN I--means the State-operated program that provides certain benefits on a fee-for-service basis through the DMAHS for Plan D parents/caretakers with a program status code of 380.
Sample 1
Special Medicaid Programs to uninsured children below the age of 19 with family incomes above 150 percent and up to and including 200 percent of the federal poverty level. Eligibles are required to participate in cost-sharing in the form of monthly premiums and a personal contribution to care for most services. In addition to covered managed care services, eligibles under this program may access certain other services which are paid fee-for-service and not covered under this contract. NJ FAMILYCARE PLAN D--means the State-operated program which provides managed care coverage to uninsured: - Adults and couples without dependent children under the age of 19 with family incomes above 50% and up to and including 100 percent of the federal poverty level; - Parents/caretakers with children below the age of 19 who do not qualify for AFDC Medicaid with family incomes up to and including 200 percent of the federal poverty level; and - Children below the age of 19 with family incomes between 201 percent and up to and including 350 percent of the federal poverty level. Eligibles with incomes above 150 percent of the federal poverty level are required to participate in cost sharing in the form of monthly premiums and copayments for most services. These groups are identified by Program Status Codes (PSCs) on the eligibility system as indicated below. For clarity, the codes related to Plan D non-cost sharing groups are also listed: Cost Sharing No Cost Sharing ------------ --------------- 493 497 494 763 495 498 In addition to covered managed care services, eligibles under these programs may access certain services which are paid fee-for-service and not covered under this contract.
Sample 1

Related to Special Medicaid Programs

  • Health Care Compliance Neither the Company nor any Affiliate has, prior to the Effective Time and in any material respect, violated any of the health care continuation requirements of COBRA, the requirements of FMLA, the requirements of the Health Insurance Portability and Accountability Act of 1996, the requirements of the Women's Health and Cancer Rights Act of 1998, the requirements of the Newborns' and Mothers' Health Protection Act of 1996, or any amendment to each such act, or any similar provisions of state law applicable to its Employees.

  • Employee Benefit Programs, Plans and Practices The Company shall during the Term provide Executive with coverage under all employee pension and welfare benefit programs, plans and practices (to the extent permitted under any employee benefit plan) in accordance with the terms thereof, which the Company generally makes available to its senior executives.

  • HIPAA HMO shall comply with applicable provisions of HIPAA. This includes, but is not limited to, the requirement that the HMO’s MIS system comply with applicable certificate of coverage and data specification and reporting requirements promulgated pursuant to HIPAA. HMO must comply with HIPAA EDI requirements.

  • Anti-Money Laundering and Red Flag Identity Theft Prevention Programs The Trust acknowledges that it has had an opportunity to review, consider and comment upon the written procedures provided by USBFS describing various tools used by USBFS which are designed to promote the detection and reporting of potential money laundering activity by monitoring certain aspects of shareholder activity as well as written procedures for verifying a customer’s identity (collectively, the “Procedures”). Further, the Trust has determined that the Procedures, as part of the Trust’s overall anti-money laundering program and the Red Flag Identity Theft Prevention program, are reasonably designed to prevent the Fund from being used for money laundering or the financing of terrorist activities and to achieve compliance with the applicable provisions of the Fair and Accurate Credit Transactions Act of 2003 and the USA Patriot Act of 2001 and the implementing regulations thereunder. Based on this determination, the Trust hereby instructs and directs USBFS to implement the Procedures on the Trust’s behalf, as such may be amended or revised from time to time. It is contemplated that these Procedures will be amended from time to time by the parties as additional regulations are adopted and/or regulatory guidance is provided relating to the Trust’s anti-money laundering and identity theft responsibilities. USBFS agrees to provide to the Trust:

  • Health Plans All MAMP Benefit Plans that are group health plans, including health care flexible spending accounts, have been operated in compliance in all material respects with the requirements of Section 4980B of the Code and Parts 6 and 7 of Title I of ERISA, to the extent those requirements are applicable. No MAMP Benefit Plan provides (or has any obligation to provide) postretirement medical or life insurance benefits to any Service Providers, except as otherwise required under state or Federal benefits continuation Laws. No MAMP Benefit Plan that is a Welfare Plan is (i) a “multiple employer welfare arrangement” within the meaning of Section 3(40) of ERISA, or (ii) a “voluntary employees’ beneficiary association” within the meaning of 501(c)(9) of the Code or other funding arrangement for the provision of welfare benefits (such disclosure to include the amount of any such funding), or (iii) self-insured by MAMP or any MAMP Subsidiary. None of MAMP, the MAMP Subsidiaries or the MAMP Benefit Plans have failed to comply with the Patient Protection and Affordable Care Act and its companion xxxx, the Health Care and Education Reconciliation Act of 2010, to the extent applicable, whether as a matter of substantive Law or in order to maintain any intended Tax qualification, and no excise Tax, penalty, or assessable payment under the Patient Protection and Affordable Care Act of 2010, as amended, and all regulations thereunder, including Section 4980H of the Code, is outstanding, has accrued, or has arisen with respect to any period prior to the Closing.

  • Health Care Matters Without limiting the generality of any representation or warranty made in Article 7 or any covenant made in Articles 8 or 9, each Borrower represents and warrants on a joint and several basis to and covenants with the Administrative Agent and each Lender, and shall be deemed to represent, warrant and covenant on each day on which any advance or accommodation in respect of any Loan is requested or made or any Liabilities shall be outstanding under this Agreement (or any Affiliate Term Loan Liabilities shall be outstanding under the Term Loan Agreement), that:

  • Anti-Money Laundering Program Services BNYM will perform one or more of the services described in subsections (1) through (7) of this Section 3(b) if requested by the Fund and the Fund agrees to pay the fees applicable to the service as set forth in the Fee Agreement (“AML Services”).

  • Health Care Benefits An amount equal to three (3) times the full annual cost of coverage for medical, dental and vision benefits under the Company’s Health Care Plan and Vision Insurance Plan provided to Executive and his covered dependents for the year in which Executive’s Covered Termination Date occurs, in a lump sum in cash within sixty (60) days after the Covered Termination Date. In no event shall the benefits provided for in Sections 2(a), (d), (e) and (f) above or any payment provided for in (c) above that is not subject to Code Section 409A be paid later than March 15th of the calendar year immediately following the calendar year in which the Executive’s Covered Termination Date occurs.

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • Healthcare Compliance 10 (v) Fraud and Abuse................................................11 (w)

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