Eligibility File Clause Samples

The Eligibility File clause defines the requirements and procedures for submitting and maintaining a list of individuals who are eligible for coverage or participation under an agreement, such as an insurance policy or employee benefit plan. Typically, this clause specifies the format, timing, and content of the eligibility file, as well as the responsibilities of the parties in updating and verifying the information. For example, an employer may be required to provide a monthly electronic file listing all employees eligible for health benefits, including relevant personal and employment details. The core function of this clause is to ensure accurate and up-to-date records, which helps prevent disputes over coverage and facilitates efficient administration of benefits.
Eligibility File. The compilation of all Eligibility Data for an Enrollee or group of Enrollees into a single electronic format used to store or transmit the data.
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Eligibility File. From time to time, Employer will (directly or through an agent) either send an electronic file or upload to HQY’s website (each, an “Eligibility File”) information pertaining to: (i) employees who have submitted HSA applications through Employer’s benefits enrollment system and instructed Employer to open HSAs on their behalf, or (ii) employees for whom Employer is requesting that HSAs be opened without the employees’ affirmative consent.
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Eligibility File. The compilation of all Eligibility Information for an Enrollee or group of Enrollees into a single electronic format used to store or transmit the data. Employee – A “qualified Employee,” as defined in 45 C.F.R. 155.20. Employer – A “qualified Employer,” as defined in § 1312(f)(2) of the Act. Encounter – Any dental service or bundle of related dental services provided to one Enrollee by one Health Care Professional within one time period. Any dental services provided must be recorded in the Enrollee’s health record. Encounter Data – Encounter information Contractor can use to demonstrate the provision of dental services to Enrollees. Enrollee – Enrollee means each and every individual or an Employee and each of their Family Members enrolled in a QDP offered through the Exchange for the purpose of receiving health benefits. An Enrollee may be referred to as a member of a QDP who is entitled to receive covered services. Evidence of Coverage (EOC) and Disclosure Form – The booklet(s) which describe(s) the benefits, exclusions, limitations, conditions, and the benefit levels of the applicable Plan(s). The Exchange – The California Health Benefit Exchange, doing business as Covered California and an independent entity within the State of California. Explanation of Benefits (EOB) – A statement sent from the Contractor to an Enrollee listing services provided, amount billed, eligible expenses and payment made by the Plan. Explanation of Payment (EOP) – A statement sent from the Contractor to Providers detailing payments made for Health Care Services. Family Dental Plan – A plan certified by the Exchange that provides the pediatric dental benefits required in Health and Safety Code 1367.005(a)(5) and Insurance Code 10122.27(a)(5), and also includes coverage for certain benefits for adult Enrollees. Family Member – An individual who is within an Enrollee’s or Employee’s family, as defined in 26 U.S.C. 36B (d)(1). General Agent – A licensed insurance brokerage firm, qualified and operating under the laws of the state of California, with a network of affiliated Agents in the state of California, that is contracted with the Exchange. Grace Period – A specified time following the premium due date during which coverage remains in force and an Enrollee or Employer or other authorized person or entity may pay the premium without penalty. Health Care Professional – An individual with current and appropriate licensure, certification, or accreditation in a medical, dental or...
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Eligibility File. The CONTRACTOR must accept an eligibility file update on a schedule agreed upon by the DEPARTMENT’S IAS vendor and the CONTRACTOR, and accurately process the enrollment file additions, changes, and deletions within three (3) BUSINESS DAYS of receipt of the file. Delays in processing the eligibility file must be communicated to the DEPARTMENT Program Manager or designee within one (1)
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Eligibility File. The compilation of all Eligibility Information for an Enrollee or group of Enrollees into a single electronic format used to store or transmit the data. Employee – A “qualified Employee,” as defined in 45 C.F.R. § 155.20. Employer – A “qualified Employer,” as defined in § 1312(f)(2) of the Affordable Care Act. Encounter – Any dental service or bundle of related dental services provided to one Enrollee by one Health Care Professional within one time period. Any dental services provided must be recorded in the Enrollee’s health record. Encounter Data – Encounter information Contractor can use to demonstrate the provision of dental services to Enrollees. Enrollee – Enrollee means each and every individual or an Employee and each of their Family Members enrolled in a QDP offered through the Exchange for the purpose of receiving health benefits. An Enrollee may be referred to as a member of a QDP who is entitled to receive covered services. Evidence of Coverage (EOC) and Disclosure Form – The booklet(s) which describe(s) the benefits, exclusions, limitations, conditions, and the benefit levels of the applicable Plan(s). The Exchange – The California Health Benefit Exchange, doing business as Covered California and an independent entity within the State of California.
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Eligibility File. The compilation of all Eligibility Information for an Enrollee or group of Enrollees into a single electronic format used to store or transmit the data. Employee – A “qualified employee,” as defined in 45 C.F.R. 155.20. Employer – A “qualified employer,” as defined in §Section 1312(f)(2) of the Act. Encounter – Any dental service or bundle of related dental services provided to one Enrollee by one Health Care Professional within one time period. Any dental services provided must be recorded in the Enrollee’s health record. Encounter Data – Encounter information Contractor can use to demonstrate the provision of dental services to Enrollees. Enrollee – Enrollee means each and every individual or an Employee and each of their Family Members enrolled in a QDP offered through the Exchange for the purpose of receiving health benefits. An Enrollee may be referred to as a member of a QDP who is entitled to receive covered services. Evidence of Coverage (EOC) and Disclosure Form – The booklet(s) which describe(s) the benefits, exclusions, limitations, conditions, and the benefit levels of the applicable Plan(s). The Exchange – The California Health Benefit Exchange, doing business as Covered California and an independent entity within the State of California.
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Eligibility File. The compilation of all Eligibility Information for an Enrollee or group of Enrollees into a single electronic format used to store or transmit the data. Employee – A “qualified Employee,” as defined in 45 C.F.R. § 155.20. Employer – A “qualified Employer,” as defined in § 1312(f)(2) of the Affordable Care Act. Encounter – Any dental service or bundle of related dental services provided to one Enrollee by one Health Care Professional within one time period. Any dental services provided must be recorded in the Enrollee’s health record. Encounter Data – Encounter information Contractor can use to demonstrate the provision of dental services to Enrollees. Enrollee – Enrollee means each and every individual enrolled in a QDP offered through the Exchange for the purpose of receiving dental benefits. An Enrollee may be referred to as a member of a QDP who is entitled to receive covered services. Evidence of Coverage (EOC) and Disclosure Form – The booklet(s) which describe(s) the benefits, exclusions, limitations, conditions, and the benefit levels of the applicable Plan(s). The Exchange – The California Health Benefit Exchange, doing business as Covered California and an independent entity within the State of California. Explanation of Benefits (EOB) – A statement sent from the Contractor to an Enrollee listing services provided, amount billed, eligible expenses and payment made by the Plan. Explanation of Payment (EOP) – A statement sent from the Contractor to Providers detailing payments made for Health Care Services. Family Dental Plan – A plan certified by the Exchange that provides the pediatric dental benefits required in Health and Safety Code § 1367.005(a)(5) and Insurance Code § 10122.27(a)(5), and also includes coverage for certain benefits for adult Enrollees. Family Member – An individual who is within an Enrollee’s or Employee’s family, as defined in 26 U.S.C.
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Eligibility File. DHS will provide Maximus a daily Eligibility File that includes records for all newly eligible Participants. ▇▇▇▇▇▇▇ shall use the Daily Eligibility File to confirm the Participant's program enrollment, update Maximus' system with any Participant demographic changes and Disenrollments, and for such other purposes as may be designated by the Department. In addition, for CHC Participants, ▇▇▇▇▇▇▇ shall use the auto-assignment indicator from the Eligibility File to determine outreach, CHC MCO selections, and the mailing of appropriate notices and packets. ▇▇▇▇▇▇▇ must reconcile any CHC Participant CHC-MCO selections in the Eligibility File that differ from the CHC Participants' advanced plan selections. The Department will treat any Depattment requested changes to required uses of the file as a change under Section IV-3.D.
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Related to Eligibility File

  • Program Eligibility The COUNTY shall provide eligibility determination for those persons applying for home repair under this Agreement by using the following factors: 1. The applicant is a resident of the CITY; and 2. The total income for all members of the applicant’s household does not exceed 80% of the median income of the Kansas City metropolitan area, as determined by the Secretary of Housing and Urban Development; and 3. The applicant is the homeowner and must have occupied the property as a primary residence for at least six (6) months; 4. The property to be repaired is within the corporate limits of the CITY; and 5. When required, medical need will be substantiated and documented.

  • Eligibility It will notify the Issuer and the Servicer promptly if it no longer meets the eligibility requirements in Section 5.1.

  • Eligibility Verification (a) HHSC will verify Medicaid eligibility for Dual Eligible Members by the fifth business day of the month following the receipt of the MA Dual SNP’s monthly enrollment file, in accordance with Section 3.02(b). (b) To verify Medicaid eligibility of an individual Member, HHSC agrees to provide the MA Dual SNP with real-time access to HHSC’s claims administrator’s Medicaid eligibility verification system.

  • CONTINUING ELIGIBILITY To continue health benefits, a permanent intermittent employee must be credited with a minimum of 480 paid hours in a control period or 960 paid hours in two consecutive control periods.

  • Student Eligibility The LEA and POSTSECONDARY INSTITUTION shall qualify and advise candidates for dual credit from the pool of eligible high school students. A candidate for dual credit is eligible for consideration for fall, spring, and summer semesters if he or she: a. is enrolled during the fall and spring in a LEA in one-half or more of the minimum course requirements approved by PED for public school students under its jurisdiction or by being in physical attendance at a bureau of Indian education-funded high school at least three documented contact hours per day pursuant to 25 CFR 39.211(c); b. obtains permission from the LEA representative (in consultation with the student’s individualized education program team, as needed), the student’s parent or guardian if the student is under 18 years old, and POSTSECONDARY INSTITUTION representative prior to enrolling in a dual credit course; and c. meets POSTSECONDARY INSTITUTION requirements to enroll as a dual credit student.