Enhanced Benefit Program Sample Clauses

The Enhanced Benefit Program clause establishes additional or superior benefits for eligible participants beyond the standard offerings. Typically, this clause outlines the specific criteria for eligibility, the nature of the enhanced benefits—such as increased coverage, extra services, or higher reimbursement rates—and the process for accessing these benefits. Its core practical function is to incentivize participation or reward certain behaviors by providing greater value, thereby promoting engagement and satisfaction among participants.
Enhanced Benefit Program a. The Agency has identified a combination of covered and non-covered services as healthy behaviors that will earn credits for an enrollee. The Agency shall assign a specific credit to an enrollee’s account for each healthy behavior service received and notify each enrollee of the availability of the credits in the account. The credits in the enrollee’s account shall be available if the enrollee enrolls in a different Health Plan and for a period of up to one (1) year after loss of Medicaid eligibility. b. The Agency shall administer the program with assistance from the Health Plan. (1) For covered services identified as healthy behaviors, the Health Plan shall submit a monthly report to the Medicaid Bureau of Contract Management (MCM) by the tenth calendar day of the month for the previous month’s paid claims. See Attachment II, Section XII, Reporting Requirements. A list of procedure codes and healthy behaviors will be provided in the Agency Report Guide posted on the Agency’s website at: ▇▇▇▇://▇▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/Medicaid/medicaid_reform/index.shtml#eb. (2) For non-Medicaid services, the Health Plan shall assist the enrollee in obtaining and submitting documentation to MCM to verify participation in a healthy behavior without a procedure code. A universal form shall be available with the Agency’s website at: ▇▇▇▇://▇▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/Medicaid/medicaid_reform/index.shtml#eb and must be submitted to the Health Plan to document participation in healthy behaviors without a procedure code. c. The Agency may add or delete healthy behaviors with thirty (30) calendar days’ written notice. This provision replaces Attachment II, Section III, Eligibility and Enrollment, Item A., Enrollee Services, sub-item 5.b., of this Contract as follows: The Health Plan shall assign a PCP to those enrollees who did not choose a PCP at the time of Health Plan selection. All HIV/AIDS enrollees who are assigned to a PCP must be assigned to a provider experienced in the provision and management of medical and psycho-social health care for persons with HIV/AIDS. The Health Plan shall also take into consideration, when possible, the enrollee’s last PCP if the PCP is known and available in the Health Plan’s network. If the last PCP is unknown, then the Health Plan shall take into consideration the PCP closest to the enrollee’s home address and zip code location, age (adults versus children/adolescents) and gender (OB/GYN), and keep children/adolescents within the same family together....
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Related to Enhanced Benefit Program

  • Compensation/Benefit Programs During the Term of Employment, the Executive shall be entitled to participate in all medical, dental, hospitalization, accidental death and dismemberment, disability, travel and life insurance plans, and any and all other plans as are presently and hereinafter offered by the Company to its executive personnel, including savings, pension, profit-sharing and deferred compensation plans, subject to the general eligibility and participation provisions set forth in such plans.

  • Benefit Programs The Executive shall be eligible to participate in any plans, programs or forms of compensation or benefits that the Company or the Company’s subsidiaries provide to the class of employees that includes the Executive, on a basis not less favorable than that provided to such class of employees, including, without limitation, group medical, disability and life insurance, paid time-off, and retirement plan, subject to the terms and conditions of such plans, programs or forms of compensation or benefits.

  • Retiree Medical Benefits If Executive is or would become fifty-five (55) or older and Executive's age and service equal sixty-five (65) and Executive has at least five (5) years of service with the Company within two (2) years of Change in Control, Executive is eligible for retiree medical benefits (as such are determined immediately prior to Change in Control). Executive is eligible to commence receiving such retiree medical benefits based on the terms and conditions of the applicable plans in effect immediately prior to the Change in Control.

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • EMPLOYEE BENEFIT PROGRAM (i) During the TERM, the EMPLOYEE shall be entitled to participate in all formally established employee benefit, bonus, pension and profit-sharing plans and similar programs that are maintained by the EMPLOYERS from time to time, including programs in respect of group health, disability or life insurance, reimbursement of membership fees in civic, social and professional organizations and all employee benefit plans or programs hereafter adopted in writing by the Boards of Directors of the EMPLOYERS, for which senior management personnel are eligible, including any employee stock ownership plan, stock option plan or other stock benefit plan (hereinafter collectively referred to as the "BENEFIT PLANS"). Notwithstanding the foregoing sentence, the EMPLOYERS may discontinue or terminate at any time any such BENEFIT PLANS, now existing or hereafter adopted, to the extent permitted by the terms of such plans and shall not be required to compensate the EMPLOYEE for such discontinuance or termination. (ii) After the expiration of the TERM or the termination of the employment of the employee for any reason other than JUST CAUSE (as defined hereinafter), the EMPLOYERS shall provide a group health insurance program in which the EMPLOYEE and his spouse will be eligible to participate and which shall provide substantially the same benefits as are available to retired employees of the EMPLOYERS on the date of this AGREEMENT until both the EMPLOYEE and his spouse become 65 years of age; provided, however that all premiums for such program shall be paid equally by the EMPLOYERS and the EMPLOYEE and/or his spouse after the EMPLOYEE's retirement; provided further, however, that the EMPLOYEE may only participate in such program for as long as the EMPLOYERS elect in their sole discretion to make available an employee group health insurance program which permits the EMPLOYERS to make coverage available for retirees.