HEALTH BENEFIT PROGRAM definition

HEALTH BENEFIT PROGRAM means the Group Health Insurance Program that provides group health BENEFITS to eligible State of Wisconsin and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes. This program is established, maintained and administered by the BOARD. HIGH DEDUCTIBLE HEALTH PLAN (HDHP) as defined in UNIFORM BENEFITS. HOSPITAL as defined in UNIFORM BENEFITS. IN-NETWORK refers to a provider who has agreed in writing by executing a participation agreement to provide, prescribe or direct health care services, supplies or other items covered under the policy to PARTICIPANTS. The provider's written participation agreement must be in force at the time such services, supplies or other items covered under the policy are provided to a PARTICIPANT. The CONTRACTOR agrees to give PARTICIPANTS lists of affiliated providers. Some providers require prior authorization by the CONTRACTOR in advance of the services being provided. INPATIENT means a PARTICIPANT admitted as a bed patient to a health care facility or in twenty-four (24)-hour home care. IT’S YOUR CHOICE OPEN ENROLLMENT means the enrollment period referred to in the DEPARTMENT materials as the It’s Your Choice enrollment period that is available at least annually to insured SUBSCRIBERS allowing them the opportunity to change CONTRACTORS and/or coverage and also to eligible individuals to enroll for coverage in any CONTRACTOR offered by the BOARD. LOCAL means a Wisconsin Public Employer who has acted under Wis. Stat. § 40.51 (7), to participate in the HEALTH BENEFIT PROGRAM for its EMPLOYEES. MINIMUM PROVIDER ACCESS STANDARDS means those as defined under Wis. Stat. § 609.22 and Wis. Admin. Code INS 9.32. OUT-OF-NETWORK refers to a provider who does not have a signed participating provider agreement and is not listed on the most current edition of the CONTRACTOR’S professional directory of providers. Care from an OUT-OF-NETWORK provider may require prior-authorization from the CONTRACTOR unless it is an emergency or urgent care. PARTICIPANT means the SUBSCRIBER or any of the SUBSCRIBER'S DEPENDENTS who have been specified by the DEPARTMENT for enrollment and are entitled to BENEFITS. PHARMACY BENEFIT MANAGER (PBM) as defined in UNIFORM BENEFITS. PREMIUM means the rates shown in the It’s Your Choice materials that includes the medical, pharmacy, and dental (when applicable) components, and administration fees required by the BOARD. Those rates may be...
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HEALTH BENEFIT PROGRAM means the program that provides group health BENEFITS to eligible State of Wisconsin and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes. This program is established, maintained and administered by the BOARD. IDENTIFICATION CARDS or ID CARDS means cards indicating eligibility of PARTICIPANTS, printed in the most current NCPDP (National Council for Prescription Drug Processing) version. These cards will be distributed upon initial enrollment, upon a change in the PHARMACY BENEFIT PLAN, or upon request of the PARTICIPANT. IT’S YOUR CHOICE OPEN ENROLLMENT or IYC means the enrollment period referred to in the DEPARTMENT materials as the IYC enrollment period that is available at least annually to insured SUBSCRIBERS allowing them the opportunity to change health plans and/or coverage and also to eligible individuals to enroll for coverage in any health plan offered by the BOARD. LOCAL means a Wisconsin Public Employer who has acted under Wis. Stat. § 40.51 (7), to participate in the HEALTH BENEFIT PROGRAM for its EMPLOYEES. ONLINE TRANSACTION PROCESSING means the process of settling claims, from submission through final disposition, between two or more parties. PARTICIPANT means the SUBSCRIBER or any of the SUBSCRIBER'S DEPENDENTS who have been specified by the DEPARTMENT for enrollment and are entitled to BENEFITS. PARTICIPATING PHARMACY means a pharmacy or a company that is authorized to represent one or more subsidiary, affiliated, or franchised pharmacies, that has entered into a PARTICIPATING PHARMACY agreement with CONTRACTOR to provide COVERED PRODUCTS to PARTICIPANTS. PARTICIPATING PRESCRIBERS means those prescribers who are authorized to prescribe medication to PARTICIPANTS under the PHARMACY BENEFIT PLAN. PBM means Pharmacy Benefit Manager.
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HEALTH BENEFIT PROGRAM means the Group Health Insurance Program that provides group health BENEFITS to eligible State of Wisconsin and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes. The HEALTH BENEFIT PROGRAM is established, maintained and administered by the BOARD. HIGH DEDUCTIBLE HEALTH PLAN (HDHP) as defined in UNIFORM BENEFITS. HOSPITAL as defined in UNIFORM BENEFITS. IN-NETWORK refers to a provider who has agreed in writing by executing a participation agreement to provide, prescribe or direct health care services, supplies or other items covered under the policy to PARTICIPANTS. The provider's written participation agreement must be in force at the time such services, supplies or other items covered under the policy are provided to a PARTICIPANT. The CONTRACTOR agrees to give PARTICIPANTS lists of affiliated providers. Some providers require prior authorization by the CONTRACTOR in advance of the services being provided. INPATIENT means a PARTICIPANT admitted as a bed patient to a health care facility or in twenty-four (24)-hour home care. IT’S YOUR CHOICE OPEN ENROLLMENT means the enrollment period referred to in the DEPARTMENT materials as the It’s Your Choice enrollment period that is available at least annually to insured SUBSCRIBERS allowing them the opportunity to change CONTRACTORS and/or coverage and also to eligible individuals to enroll for coverage in any CONTRACTOR offered by the BOARD. LOCAL means a Wisconsin Public Employer who has acted under Wis. Stat. § 40.51 (7), to participate in the HEALTH BENEFIT PROGRAM for its EMPLOYEES. MEDICARE ADVANTAGE means a program defined under Title 18, Part C of the U.S. Social Security act of 1965, as amended.
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Examples of HEALTH BENEFIT PROGRAM in a sentence

  • The BOARD may allow an organization that has substantially but not completely met the requirements of this AGREEMENT to participate but not be considered qualified in the first year of operation in the HEALTH BENEFIT PROGRAM for purposes of establishing the EMPLOYER contribution toward PREMIUM when the contribution is based on a percentage of the lowest / average cost qualified plan.

  • The CONTRACTOR’S dedicated toll-free customer service telephone number shall be operational and customer service staff for the HEALTH BENEFIT PROGRAM are trained.

  • All medical claims administrative services for the HEALTH BENEFIT PROGRAM shall be fully operational.

  • Unless otherwise requested by the DEPARTMENT, each report must be specific to data from the HEALTH BENEFIT PROGRAM, not general data from the CONTRACTOR’S book of business.

  • A PARTICIPANT’S right to BENEFITS is subject to the terms, conditions, limitations and exclusions of the HEALTH BENEFIT PROGRAM.

  • The organization must submit a proposal to the BOARD to participate in the HEALTH BENEFIT PROGRAM.

  • A SUBSCRIBER cannot choose to exclude any eligible DEPENDENT from family coverage, unless that DEPENDENT is already covered under the HEALTH BENEFIT PROGRAM.

  • HEALTH BENEFIT PROGRAM means the program that provides group health BENEFITS to eligible State of Wisconsin and participating LOCAL EMPLOYEES, ANNUITANTS, CONTINUANTS and their eligible DEPENDENTS in accordance with Chapter 40, Wisconsin Statutes.

  • The BOARD requires the information concerning any change in ownership or controlling interest, any merger or any acquisition of another entity in order to fulfill the BOARD's responsibility to assess the effects of the pending action upon the best interests of the HEALTH BENEFIT PROGRAM and its PARTICIPANTS.

  • Any participating STATE EMPLOYEE who terminates employment after attaining twenty (20) years of WRS creditable service, remains an inactive WRS participant and is ineligible for an immediate annuity (that is, under the minimum retirement age) may enroll in the HEALTH BENEFIT PROGRAM at a later date.


More Definitions of HEALTH BENEFIT PROGRAM

HEALTH BENEFIT PROGRAM means a benefit program (i) specifying health care services to be reimbursed, paid for or provided to individuals lawfully participating in that benefits program; (ii) employing financial incentives to utilize Participating Providers; and (iii) issued, administered or serviced by AHM or an Affiliate.
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Related to HEALTH BENEFIT PROGRAM

  • Health benefits plan means a benefits plan which pays or

  • Health Benefits means health maintenance organization, insured or self-funded medical, dental, vision, prescription drug and behavioral health benefits.

  • Health benefit plan means a policy, contract, certificate or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.

  • Basic health benefit plan means any plan offered to an individual, a small group,

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Health plan or "health benefit plan" means any policy,

  • Retiree means any person who has begun accruing a retirement

  • Health insurance plan means any health insurance policy or health benefit plan offered by a health insurer or a subcontractor of a health insurer, as well as Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State. The term includes vision care plans but does not include policies or plans providing coverage for a specified disease or other limited benefit coverage.

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

  • 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:

  • Health Plans means any and all individual and family health and hospitalization insurance and/or self-insurance plans, medical reimbursement plans, prescription drug plans, dental plans and other health and/or wellness plans.

  • Retirement Plans means the retirement income, supplemental executive retirement, excess benefits and retiree medical, life and similar benefit plans providing retirement perquisites, benefits and service credit for benefits at least as great in the aggregate as are payable thereunder prior to a Change in Control;

  • 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.

  • 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.

  • Basic health plan means the plan described under chapter

  • 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.

  • health worker means a person who has completed a course of

  • 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:

  • Health and Welfare Benefits means any form of insurance or similar benefit programs, which may include but not be limited to, medical, hospitalization, surgical, prescription drug, dental, optical, psychiatric, life, or long-term disability.

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Group health insurance coverage means in connection with a group health plan, health insurance

  • Pharmacy benefit manager means a person, business or other

  • Retirement Plan means a plan which provides retirement benefits to you and which is not funded wholly by your contributions. The term shall not include a profit-sharing plan, informal salary continuation plan, registered retirement savings plan, stock ownership plan, 401(K) or a non-qualified plan of deferred compensation.

  • Pension Benefits Act means The Pension Benefits Act of Ontario and regulations thereunder as amended from time to time.

  • Health insurance means protection which provides payment of benefits for covered sickness or injury.