§ 411.100 Basis and scope
§ 411.101 Definitions
§ 411.102 Basic prohibitions and requirements
§ 411.103 Prohibition against financial and other incentives
§ 411.104 Current employment status
§ 411.106 Aggregation rules
§ 411.108 Taking into account entitlement to Medicare
§ 411.110 Basis for determination of nonconformance
§ 411.112 Documentation of conformance
§ 411.114 Determination of nonconformance
§ 411.115 Notice of determination of nonconformance
§ 411.120 Appeals
§ 411.121 Hearing procedures
§ 411.122 Hearing officer’s decision
§ 411.124 Administrator’s review of hearing decision
§ 411.126 Reopening of determinations and decisions
§ 411.130 Referral to Internal Revenue Service (IRS)

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B > Part 411 > Subpart E - Limitations On Payment for Services Covered Under Group Health Plans: General Provisions

  • Allegation: something that someone says happened.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. Source: OCC
  • Oath: A promise to tell the truth.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Remand: When an appellate court sends a case back to a lower court for further proceedings.
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Testify: Answer questions in court.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.