PCP‐to Sample Clauses

PCP‐to. Enrollee ratio. Contractor’s maximum PCP panel size shall be as set forth below. If Contractor does not satisfy the PCP requirements set forth below, Contractor may demonstrate compliance with these requirements by demonstrating that Contractor’s full‐time‐equivalent PCP ratios exceed ninety percent (90%) of the requirements set forth below, and that Covered Services are being provided in the Contracting Area in a manner that is timely and otherwise satisfactory. Contractor shall comply with Section 1932(b)(7) of the Social Security Act. 5.8.8.1 For the Families and Children Population and ACA Adult Enrollees, Contractor’s maximum PCP panel size shall be one‐ thousand eight‐hundred (1,800) Enrollees. An additional maximum of nine hundred (900) of such Enrollees is allowed for each resident Physician, nurse practitioner, Physician assistant, and APN who is one‐hundred percent (100%) full‐time equivalent employee or contractor. 5.8.8.2 For Seniors and Persons with Disabilities Enrollees, Contractor’s maximum PCP panel size shall be six hundred (600) Enrollees.

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  • Programs to Keep You Healthy Many health problems can be prevented by making positive changes to your lifestyle, including exercising regularly, eating a healthy diet, and not smoking. As a member, you can take advantage of our wellness programs at no additional cost. We offer wellness programs to our members from time to time. These programs include, but are not limited to: • online and in-person educational programs; • health assessments; • coaching; • biometric screenings, such as cholesterol or body mass index; • discounts We may provide incentives for you to participate in these programs. These incentives may include credits toward premium, and a reduction or waiver of deductible and/or copayments for certain covered healthcare services, as permitted by applicable state and federal law. For the subscriber of the plan, wellness incentives may also include rewards, which may take the form of cash or cash equivalents such as gift cards, discounts, and others. These rewards may be taxable income. Additional information is available on our website. Your participation in a wellness program may make your employer eligible for a group wellness incentive award. Your participation in our wellness programs is voluntary. We reserve the right to end wellness programs at any time. From time to time, we may offer you coupons, discounts, or other incentives as part of our member incentives program. These coupons, discounts and incentives are not benefits and do not change or affect your benefits under this plan. You must be a member to be eligible for member incentives. Restrictions may apply to these incentives, and we reserve the right to change or stop providing member incentives at any time. Care coordination gives you access to dedicated BCBSRI healthcare professionals, including nurses, dietitians, behavioral health providers, and community resources specialists. These care coordinators can help you set and meet your health goals. You can receive support for many health issues, including, but not limited to: • making the most of your physician’s visits; • navigating through the healthcare system; • managing medications or addressing side effects; • better understanding new or pre-existing medical conditions; • completing preventive screenings; • losing weight; • accessing maternal health services, including doula services. Care Coordination is a personalized service that is part of your existing healthcare coverage and is available at no additional cost to you. For more information, please call (▇▇▇) ▇▇▇-▇▇▇▇ (2273) or visit our website. If you have a chronic condition such as asthma, coronary heart disease, diabetes, congestive heart failure, and/or chronic obstructive pulmonary disease, we’re here to help. Our tools and information can help you manage your condition and improve your health. You may also be eligible to receive help through our care coordination program. This voluntary program is available at no additional cost you. To learn more about disease management, please call (▇▇▇) ▇▇▇-▇▇▇▇ or ▇-▇▇▇-▇▇▇-▇▇▇▇. Our entire contract with you consists of this agreement and our contract with your employer. Your ID card will identify you as a member when you receive the healthcare services covered under this agreement. By presenting your ID card to receive covered healthcare services, you are agreeing to abide by the rules and obligations of this agreement. Your eligibility for benefits is determined under the provisions of this agreement. Your right to appeal and take action is described in Appeals in Section 5. This agreement describes the benefits, exclusions, conditions and limitations provided under your plan. It shall be construed under and shall be governed by the applicable laws and regulations of the State of Rhode Island and federal law as amended from time to time. It replaces any agreement previously issued to you. If this agreement changes, an amendment or new agreement will be provided.

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  • Eligible Population 5.1 Program eligibility is determined by applicable law set forth in Program rules and the requirements established in the Program Policy Manual. 5.2 The unduplicated number of Clients for PHC services is 430. This represents the Grantee’s projected number of unduplicated Clients to be served during the Contract period. If during the Contract period it is foreseen that the Grantee might be unable to serve the contracted number of children, HHSC may reduce the Grantee’s grant award amount.

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  • Bus Drivers The provisions of this Article apply to school term bus drivers except as hereinafter modified. Bus Drivers are guaranteed a base of one thousand and ninety (1090) hours per school year. Guarantee consists of 1090 hours divided by possible working days in a school year times actual number of days worked. This excludes Saturday and Sunday and General Holiday trips. (a) Regular shift is defined as the conveyance of passengers to school in the morning and home in the afternoon. (b) Extra shift is defined as the conveyance of passengers for extra-curricular activities. (c) Shifts shall be paid at a minimum of two (2) hours and drivers' time will be uninterrupted if less than one-half (½) hour remains between shifts. (i) Drivers are entitled to one 15 minute rest period after two (2) hours of work and a second rest period after six (6) hours of work. Paid waiting times of 15 minutes or more will be construed as a paid rest period regardless of the length of time spent waiting. (d) All work after nineteen hundred (1900) hours on those days on which the regular shift has been worked shall be deemed to be overtime. After twelve (12) hours from the start of the regular shift, work will be deemed as overtime. (e) Hours of work consisting of regular and extra shifts and overtime are shared as equally as possible amongst drivers. Each driver has the opportunity to choose a percentage of the work available beyond one’s guaranteed hours, although the decision of the Employer will prevail. If no drivers are available, other transportation department staff may share the work. (f) Where School District transportation is used for extra-curricular trips on Saturdays and Sundays, the following applies instead of the overtime rates in Article 10.2: (i) Time and one-half (1 ½) regular rate for driving to and from destination. (ii) Upon arrival at destination, waiting time shall be paid at the regular rate of pay. (iii) No shift will be paid less than four (4) hours. (iv) Trips that are cancelled where the driver positions into departure point/school shall be paid at two (2) hours at one and one half (1 ½) times the regular rate. (v) All work carried out in this sub paragraph 9.5(f) shall be on a volunteer basis and shared as equally as possible. All Transportation employees may participate and shall be paid at the Bus Driver rate of pay. (vi) An exception to 9.5 (f) (i) to (iv) above will apply to bus driving on ski trips. Bus drivers who drive on ski trips shall share those hours only with other registered ski trip drivers. (g) Work carried out on General Holidays shall be paid in accordance with the current contract rates. (h) At the end of each school year a review of school bus drivers’ hours of work will be made to ensure minimum guarantee is met. Any shortages will be paid out.