Disenrollment Exceptions Sample Clauses

The Disenrollment Exceptions clause defines specific circumstances under which a party may be permitted to withdraw from a program, plan, or agreement outside of the standard disenrollment process. Typically, this clause outlines qualifying events such as significant changes in personal circumstances, loss of eligibility, or administrative errors that justify an exception. By clearly specifying these exceptions, the clause ensures that parties are not unfairly bound to terms when unforeseen or uncontrollable events occur, thereby providing flexibility and fairness in the administration of the agreement.
Disenrollment Exceptions. The following members will not be subject to disenrollment due to non- payment: Members confirmed medically frail in accordance with Section 3.3.2 will not be terminated from the program due to non-payment. In the event a medically frail member with income over 100% FPL does not make a payment within sixty (60) calendar days of its due date, the Contractor shall notify the State of nonpayment as detailed in Section 4.7. However, the medically frail member will continue to receive HIP State Plan benefits, but will be required to make copayments consistent with Section 4.1.2. The Contractor shall continue to send monthly POWER Account invoices to such medically frail members above 100% FPL, and the member will continue to incur debt to the Contractor for unpaid POWER Account contributions. The Contractor shall ensure that the member’s total expenses, including any paid debt, copayments, and POWER account contributions, do not exceed the five percent (5%) of income maximum during any quarter as set forth in Section 6.16. Members may regain access to HIP State Plan Plus without copayments during their 12-month eligibility redetermination in accordance with Section 5.6. i. Parent/caretaker members receiving transitional medical assistance (TMA) as set forth in Section 3.3.1 shall either attain or remain in HIP Plus coverage for up to twelve (12) months during their TMA eligibility period as long as POWER Account contributions are made. If after the first six (6) months of TMA coverage income remains over 138% but below 185% FPL, coverage can extend an additional six (6) months as long as POWER Account contributions are paid.
View SourceView Similar (4)
Disenrollment Exceptions. The following members will not be subject to disenrollment due to non- payment: Members confirmed medically frail in accordance with Section
View SourceView Similar (3)
Disenrollment Exceptions. The following members will not be subject to disenrollment due to non-payment: Members confirmed medically frail in accordance with Section 3.3.2 will not be terminated from the program due to non-payment. In the event a medically frail member with income over 100% FPL does not make a payment within sixty
View SourceView Similar (2)

Related to Disenrollment Exceptions

  • Disenrollment 12.1 ADFMs shall be disenrolled from TOP Prime/TOP Prime Remote, TOP Select when: • The enrollee loses eligibility for TOP enrolled coverage, • The enrollee has not requested enrollment transfer/disenrollment of TOP Prime/TOP Prime Remote within 60 calendar days following the end of the overseas tour. 12.2 ADSMs shall be disenrolled from TOP Prime/TOP Prime Remote when: 12.3 ADFMs who are enrolled in TOP Prime/TOP Prime Remote may disenroll at any time. They will not be permitted to make another enrollment until after a 12-month period if they have already changed their enrollment status from enrolled to disenrolled twice during the enrollment year (October 1 to September 30) for any reason. ADFMs with sponsors E-1 through E-4 are exempt from these enrollment lock-out provisions. See Chapter 6, Section 1 for guidance regarding enrollment lock-outs. Effective January 1, 2018, see TPM, Chapter 10, Section 2.1 for QLE information and Chapter 6, Sections 1 and 2, for enrollment eligibility and time frames. 12.4 ADSMs cannot voluntarily disenroll from TOP Prime or TOP Prime Remote if they remain on permanent assignment in an overseas location where these programs are offered. ADSM enrollment in TOP Prime or TOP Prime Remote continues until they transfer enrollment to another TRICARE region/program or lose eligibility for TOP/TRICARE. 12.5 TOP Prime/TOP Prime Remote enrollees must either transfer enrollment or disenroll within 60 calendar days of the end of the overseas tour when the ADSM departs to a new area of assignment. The TOP contractor shall provide continuing coverage until (1) the enrollment has been transferred to the new location, (2) the enrollee disenrolls, or (3) when enrollment transfer or disenrollment has not been requested by the TOP Prime/TPR enrollee by the 60th day the TOP contractor will automatically disenroll the beneficiary on the 61st calendar day following the end date of the overseas tour from TOP Prime or TOP TPR. Until December 31, 2017, the disenrolled ADFM TOP Prime or TOP TPR beneficiary will revert to TRICARE Standard. Effective January 1, 2018, ADFMs disenrolled from TOP Prime or TOP TPR will be only eligible for space available care at military treatment facilities.‌

  • Enrollment You are responsible for i) having all of the required information in this Agreement completed and

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Open Enrollment KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as described above during a limited period of time specified by the Group and KFHPWA.

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.