Examples of Benefit Notice in a sentence
A valid factual dispute is a factual dispute that, if resolved in the enrollee’s favor, would entitle the enrollee to a different level of TennCare benefits than that identified in the Benefit Notice.
Provide enrollees with 40 days (inclusive of mail time) from the date of the Benefit Notice to request a hearing for valid factual disputes related to the changes in coverage and inform enrollees how they may request a hearing.
When an enrollee requests a hearing prior to the effective date of changes in coverage as identified in the Benefit Notice, the enrollee shall continue to receive benefits at the level for the eligibility category alleged by the enrollee to be currently applicable until the appeal has been resolved.
Valid factual disputes include when an enrollee claims to have received the Benefit Notice in error (e.g., he or she is already in a TennCare category that is not subject to the particular changes in coverage).
The properly completed DWC Benefit Notice shall be mailed to the employee within 14 calendar days of the first day of disability.
If the enrollee does not appeal prior to the effective date of changes in coverage as identified in the Benefit Notice, such changes in benefits will become effective, as applied to the enrollee, upon this date.
An enrollee will have the opportunity to request a state fair hearing for 40 days (inclusive of mail time) from the date of the Benefit Notice.
At least 30 days prior to the effective date of changes in coverage of TennCare benefits (e.g., implementation of pharmacy benefit limits and elimination of covered services), the state shall provide a notice (Benefit Notice) to enrollees who are impacted by such changes in coverage of TennCare benefits.
These enrollees will be granted a hearing because they did not have the opportunity to appeal the application of the benefit limit to them in connection with the Benefit Notice.
Neither the state nor the MCC will provide notification in addition to the Benefit Notice described above with respect to services that are eliminated from TennCare coverage as those services are no longer covered by TennCare.