Benefit manager definition

Benefit manager means a person who has access to and reviews patient health information, including information related to patient prescription dispensing records, for the purpose of administering a health care program operated by a health benefit plan, including utilization review and determination of coverage issues. The term includes a third-party administrator.
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Benefit manager means a person who performs one or more of
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Benefit manager means a person who performs one or more of the following functions on behalf of a carrier, third-party administrator, or self-insured company:
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Examples of Benefit manager in a sentence

  • Safety checks – Before the Member’s prescription is filled, Our pharmacy Benefit manager or We perform quality and safety checks for usage precautions, drug duplication, and frequency of refills (e.g. refill prior to seventy-five percent (75%) day supply used).

  • Some pharmacies have contracted with Us or with Our pharmacy Benefit manager to accept a negotiated amount as payment in full for the covered Prescription Drugs that they dispense.

  • When a Member purchases covered Prescription Drugs from a pharmacy that has not contracted with Us or with Our pharmacy Benefit manager to accept a negotiated amount as payment in full for the covered Prescription Drugs that it dispenses, the Allowable Charge is the negotiated amount that Participating Pharmacies have agreed to accept for drugs dispensed.

  • Some pharmacies have contracted with the Claims Administrator or with the Claims Administrator's pharmacy Benefit manager to accept a negotiated amount as payment in full for the covered Prescription Drugs that they dispense.

  • Prescription Drugs approved for self-administration (e.g., oral or self-injectable drugs) are excluded when obtained from a Physician or other Provider unless the provider is contracted with Our pharmacy Benefit manager.

  • For information on how to file Claims for foreign Prescription Drug purchases, the Member should contact Us or Our pharmacy Benefit manager at the telephone number indicated on the Member’s ID card.

  • Most Members receive information from Us by accessing the pharmacy section of Our website, www.bcbsla.com/pharmacy, or request a copy by mail by calling Our pharmacy Benefit manager at the telephone number identified on Your ID card You may also contact Us at the telephone number on Your ID card to ask whether a specific drug is included in Your formulary.

  • Most Plan Participants receive information by accessing the pharmacy section of the Claims Administrator’s website, www.bcbsla.com/pharmacy or request a copy by mail by calling the pharmacy Benefit manager at the telephone number indicated on the Plan Participant’s ID card.

  • Prescription Drugs subject to the Step Therapy program when the Step Therapy program was not utilized or the drug was not approved by Us or Our pharmacy Benefit manager; bb.

  • The Claim form should then be sent to Our pharmacy Benefit manager, whose number is on Your ID card.


More Definitions of Benefit manager

Benefit manager means the manager designated as the benefit manager of a sustainable business limited liability company under section ‑7.
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Related to Benefit manager

  • Pharmacy benefit manager means a person, business or other

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

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

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

  • Health benefits plan means a benefits plan which pays or

  • 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.

  • Designated Employer Representative (DER) means a designated school district representative authorized to take immediate action to remove employees from safety-sensitive duties, to make required decisions in the testing and evaluation process, and to receive test results and other communications for the school district.

  • Retirement board or "board" means the retirement system's governing board provided for in 2-15-1010.

  • Societal benefits charge means a charge imposed by an electric

  • SERP has the meaning assigned thereto in Section 5(c) hereof.

  • Supervisory employee means an employee, regardless of job description, having authority in the interest of the employer to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or the responsibility to assign work to and direct them, or to adjust their grievances, or effectively recommend that action, if, in connection with the foregoing functions, the exercise of that authority is not of a merely routine or clerical nature, but requires the use of independent judgment.

  • Termination Compensation means a monthly cash amount equal to one-twelfth ( 1/12th) of the highest amount of the annual cash compensation (including cash bonuses and other cash-based compensation, including for these purposes amounts earned or payable whether or not deferred) received by Executive during any one of the three (3) calendar years immediately preceding the calendar year in which Executive’s Termination Date occurs; provided, that if the cash compensation received by Executive during the Termination Year exceeds the highest amount of the annual cash compensation received by Executive during any one of the immediately preceding three (3) consecutive calendar years, the cash compensation received by Executive during the Termination Year shall be deemed to be Executive’s highest amount of annual cash compensation. In no event shall Executive’s Termination Compensation include equity-based compensation (e.g., income realized as a result of Executive’s exercise of non-qualified stock options or other stock based benefits).

  • Accrued Professional Compensation means, at any given moment, all accrued, contingent and/or unpaid fees and expenses (including, without limitation, success fees) for legal, financial advisory, accounting and other services and reimbursement of expenses that are awardable and allowable under section 328, 330(a) or 331 of the Bankruptcy Code and were rendered before the Effective Date by any Retained Professional in the Chapter 11 Cases, or that are awardable and allowable under section 503 of the Bankruptcy Code, that have not been denied by a Final Order, all to the extent that any such fees and expenses have not been previously paid (regardless of whether a fee application has been filed for any such amount). To the extent that the Bankruptcy Court or any higher court denies or reduces by a Final Order any amount of a Retained Professional’s fees or expenses, then those reduced or denied amounts shall no longer constitute Accrued Professional Compensation.

  • Medical Executive Committee or “MEC” means the Executive Committee of the Medical Staff.