Essential Benefits definition

Essential Benefits include the following: ambulatory 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. Such benefits shall be consistent with those set forth under the Patient Protection and Affordable Care Act of 2010 and any regulations issued pursuant thereto.
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Essential Benefits means: 1) Ambulatory patient services; 2) Emergency services; 3) Hospitalization; 4) Maternity and newborn care; 5) Mental health and substance abuse, including behavioral health treatment; 6) Prescription drugs; 7) Rehabilitative and habilitative services and devices; 8) Laboratory services; 9) Preventive and wellness services and chronic disease management; and 10) Pediatric services, including oral and vision care. There are no annual or lifetime dollar limits applicable to essential benefits. Any benefit-specific dollar limits referenced in the Schedule of Benefits pertain only to those health care services and supplies that are not essential benefits.
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Essential Benefits means the following categories of items and services, as those items and services are defined by federal regulation pursuant to Section 1302(b) of the federal Patient Protection and Affordable Care Act:
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Examples of Essential Benefits in a sentence

  • Subtitle C—Standards Guaranteeing Access to Essential Benefits Sec.

  • Essential Benefits do not have an annual maximum accumulated payment threshold.Adverse Determination: A determination by EmblemHealth or its agents that an admission, extension of stay, or other health care service has been reviewed and, based on the information provided, is not medically necessary, or is experimental or investigational in nature, and therefore not covered.Balance-of-Charges: Non-Network Providers have not agreed to accept EmblemHealth’s Allowed Charge as payment in full.

  • All other provisions remain as described in your Subscriber Certificate.attached to and made part ofBlue Cross and Blue Shield of Massachusetts, Inc.Dental Blue Policy BCBS-DENT (1-1-2014) Schedule of Dental BenefitsPediatric Essential Benefits This is the Schedule of Dental Benefits that is a part of your Dental Blue Policy.

  • See “State Insurance Mandates and the ACA Essential Benefits Provisions,” National Conference of State Legislators (Oct.2017).

  • This document was produced for review by the United States Agency for International Development Philippine Mission (USAID/ Philippines).PROJECT PROFILE Program:USAID/PHILIPPINESMARAWI RESPONSE PROJECT (MRP)Activity Start Date and End Date:August 29, 2018 – August 28, 2021Name of Prime Implementing Partner:Plan USA International Inc.Cooperative Agreement Number:72049218CA00007Names of Subcontractors/Sub awardees:Ecosystems Work for Essential Benefits (ECOWEB) and Maranao People Development Center, Inc.

  • There are no annual or lifetime maximum payment thresholds on Essential Benefits.

  • Except for Essential Benefits, a qualified HDHP may not provide benefits until the deductible has been met.

  • Figure 1: Estimated Premium Changes and Percent of Members Impacted Premium Impact Essential Benefits The ACA requires that all benefit plans cover services for essential health benefits, some of which are often excluded in the current individual market.

  • In the event that cover in respect of any benefit set out in the Foundation or Foundation Plus Global Health plan is lower than the benefit provided under the Dubai Health Authority Essential Benefits plan, the cover provided under the Dubai Health Authority Essential Benefits plan shall apply.

  • Establishing Essential Benefits and enhancing preventive services Comment [MK1]: Need to update prior to submission – will have resolution by 5/8Division staff worked with the Colorado Consumer Health Initiative, Colorado Association of Health Plans, the Colorado Competitive Council (business group), health care providers and many other stakeholders through a collaborative process including gathering input through dozens of public meetings, phone calls, and e-mails.


More Definitions of Essential Benefits

Essential Benefits means: 1) Ambulatory patient services; 2) Emergency services;3) Hospitalization; 4) Maternity and newborn care; 5) Mental health and substance abuse, including behavioral health treatment; 6) Prescription drugs; 7) Rehabilitative services;8) Laboratory services; 9) Preventive and wellness services and chronic disease management; 10) Pediatric services, including oral and vision care. If benefits defined as “essential” are already covered as part of this grandfathered plan, they must be covered without dollar limits in-network and out-of-network. Any other benefit-specific dollar limits referenced in the Plan pertain only to those health care services and supplies thatare not essential benefits. Note: The maximums listed below are the total for Network and Non-Network expenses. For example, if a maximum of 60 days is listed twice under a service, the Calendar Year maximumis 60 days total, which may be split between Network and Non-Network providers. DEDUCTIBLE, PER CALENDAR YEAR: All applicable In-Network monies paid by the Plan Participant toward the deductible will be combined with Non-Network monies paid for the purpose of determining whether the Non-Network deductible has been met.
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Related to Essential Benefits

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

  • 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.

  • Separation Benefits has the meaning accorded such term in Section 3.04.

  • Severance Benefits mean the payment of severance compensation as provided in Section 2.3 herein.

  • Employment benefits means all benefits provided or made

  • Termination Benefits means the benefits described in Section 4.1(b).

  • Mutual Benefits means the transient and steady-state support that the integrated generation and Transmission Systems in PJM and New York provide to each other inherently by virtue of being interconnected as described in Section 35.4 of this Agreement.

  • Additional Benefits means quantifiable and verifiable enhancement of conservation of biodiversity and/or improvement of local livelihoods realized as a result of implementation of the REDD activities;

  • 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:

  • material benefit means a benefit which may not be financial but has a monetary value;

  • 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.

  • Change in Control Benefits means the following benefits:

  • Special benefit means a particular and distinct benefit over and above general benefits conferred on real property located in the district or to the public at large. General enhancement of property value does not constitute “special benefit.”

  • Accrued Benefits shall include the following amounts, payable as described herein: (i) all base salary for the time period ending with the Termination Date; (ii) reimbursement for any and all monies advanced in connection with the Executive's employment for reasonable and necessary expenses incurred by the Executive on behalf of the Company and its Affiliates for the time period ending with the Termination Date; (iii) any and all other cash earned through the Termination Date and deferred at the election of the Executive or pursuant to any deferred compensation plan then in effect; (iv) notwithstanding any provision of any bonus or incentive compensation plan applicable to the Executive, a lump sum amount, in cash, equal to the sum of (A) any bonus or incentive compensation that has been allocated or awarded to the Executive for a fiscal year or other measuring period under the plan that ends prior to the Termination Date but has not yet been paid (pursuant to Section 5(f) or otherwise) and (B) a pro rata portion to the Termination Date of the aggregate value of all contingent bonus or incentive compensation awards to the Executive for all uncompleted periods under the plan calculated as to each such award as if the Goals with respect to such bonus or incentive compensation award had been attained; and (v) all other payments and benefits to which the Executive (or in the event of the Executive's death, the Executive's surviving spouse or other beneficiary) may be entitled as compensatory fringe benefits or under the terms of any benefit plan of the Employer, including severance payments under the Employer's severance policies and practices in the form most favorable to the Executive that were in effect at any time during the 180-day period prior to the Effective Date. Payment of Accrued Benefits shall be made promptly in accordance with the Employer's prevailing practice with respect to clauses (i) and (ii) or, with respect to clauses (iii), (iv) and (v), pursuant to the terms of the benefit plan or practice establishing such benefits.

  • Essential Human Needs means natural gas service, which, if denied, would cause shutdown of an operation resulting in the closing of the establishment essential to maintaining the health and safety of the general public.

  • 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).

  • Retirement Benefits means benefits paid by reference to reaching, or the expectation of reaching, retirement or, where they are supplementary to those benefits and provided on an ancillary basis, in the form of payments on death, disability, or cessation of employment or in the form of support payments or services in case of sickness, indigence or death. In order to facilitate financial security in retirement, these benefits may take the form of payments for life, payments made for a temporary period, a lump sum, or any combination thereof;

  • Compensation and Benefits Programs means all compensation and benefit plans, policies, and programs of the Debtors, and all amendments and modifications thereto, applicable to the Debtors’ employees, former employees, retirees, and non-employee directors and the employees, former employees and retirees of their subsidiaries, including all savings plans, retirement plans, health care plans, disability plans, and incentive plans, deferred compensation plans, and life, accidental death, and dismemberment insurance plans.

  • Covered benefits or “benefits” means those health care services to which a covered person is entitled under the terms of a health benefit plan.

  • Severance Pay means any amount that is payable in cash and is identified by a Participating Company as severance pay, or any amount which is payable on account of periods beginning after the last date on which an employee (or former employee) is required to report for work for a Participating Company.

  • Change in Control Severance Benefits means the benefits payable pursuant to Section 3 of this Agreement.

  • Employment Termination means the effective date of: (i) Executive’s voluntary termination of employment with the Company with Good Reason, or (ii) the termination of Executive’s employment by the Company without Good Cause.

  • Additional gap medical benefits means the benefits (if any) payable in respect of medical expenses that are more than the schedule fee and which otherwise meet the requirements of the fund’s no or known gap policy, provided always that the medical expenses relate to a professional service that:

  • Severance Compensation means the compensation set forth in (i), (ii), and (iv) above.

  • Severance Benefit means the payment of severance compensation as provided in Article III.

  • Vested Benefits means amounts that are vested or that Executive is otherwise entitled to receive, without the performance by Executive of further services or the resolution of a contingency, under the terms of or in accordance with any investment and savings plan or retirement plan (including any plan providing retiree medical benefits) of the Company or its affiliates, and any ERPs or ESPs related thereto, and any deferred compensation or employee stock purchase plan or similar plan or program of the Company or its affiliates.