Disenrollment from MSHO But Not From MSC+ Clause Samples

This clause defines the process and implications when a member is disenrolled from the Minnesota Senior Health Options (MSHO) program but remains enrolled in the Minnesota Senior Care Plus (MSC+) program. In practice, it outlines the administrative steps and coverage changes that occur, such as the transition of benefits and the responsibilities of the health plan to notify the member and coordinate ongoing care. The core function of this clause is to ensure continuity of care and clarify the rights and obligations of both the member and the health plan during a partial program disenrollment, thereby preventing gaps in coverage and confusion.
Disenrollment from MSHO But Not From MSC+. ‌ The Enrollee may disenroll from the MCO’s MSHO product at the end of any thirty (30) day period of consecutive enrollment. Disenrollment will be effective according to the termination of coverage schedules outlined in section 3.5.6. Additional conditions for disenrollment from MSHO include: 3.5.1.1 If the Enrollee disenrolls from the MCO’s MSHO product, the Enrollee shall remain enrolled in the MCO’s MSC+ product, subject to the MCO’s participation requirement in 12.7.1, unless the Enrollee requests the STATE to return them to the MSC+ product in which they were enrolled immediately prior to enrollment in MSHO. 3.5.1.2 If the Enrollee has a Medical Spenddown, the Enrollee shall not be re-enrolled in MSC+ as this is an excluded population group under that program. 3.5.1.3 An Enrollee who disenrolls from the MCO’s MSHO product and remains enrolled in the MCO’s MSC+ product shall be enrolled in the MCO’s MSC+ product for a period of twelve (12) months, subject to the exceptions in sections 3.2.7 and 3.5.3 (as applicable), and 5.1.2 of this Contract. 3.5.1.4 If the MSHO MCO does not offer an MSC+ product because they are not the single plan operating in that Service Area, the Enrollee will be automatically assigned to the MSC+ plan serving that area.
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Disenrollment from MSHO But Not From MSC+. The Enrollee may disenroll from the MCO’s MSHO product at the end of any thirty (30) day period of consecutive enrollment. Disenrollment will be effective according to the termination of coverage schedules outlined in section 3.2.
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