Disenrollment Prohibitions Sample Clauses
The Disenrollment Prohibitions clause restricts the circumstances under which a party, such as a member or participant, can be removed or excluded from a program, plan, or service. Typically, this clause outlines specific conditions that must not be used as grounds for disenrollment, such as non-payment of minor fees or changes in health status, and may require that any removal follows a defined process. Its core function is to protect participants from arbitrary or unfair removal, ensuring stability and fairness within the agreement.
Disenrollment Prohibitions. Enrollees shall not be disenrolled from the Contractor's MMC or FHPlus product based on any of the factors listed in Section 34 (Non-Discrimination) of this Agreement.
Disenrollment Prohibitions. Disenrollment shall not be based in whole or in part on any of the following reasons:
a) an existing condition or a change in the Enrollee's health which would necessitate disenrollment pursuant to the terms of this Agreement, unless the change i) results in the Enrollee being reclassified into an excluded category for Medicaid managed care as listed in Section 5.3 of this Agreement; ii) results in the Enrollee being reclassified into an exempt category as listed in Section 5.2 of this Agreement and the Enrollee wants to disenroll from managed care.
b) any of the factors listed in Section 34 - Non-Discrimination of this Agreement; or
c) on the Capitation Rate payable to the Contractor r elated to the Enrollee's participation with the Contractor.
Disenrollment Prohibitions. Enrollees shall not be disenrolled from the Contractor's Medicaid Advantage Product based on any of the following reasons:
i) an existing condition or a change in the Enrollee's health which would necessitate disenrollment pursuant to the terms of this Agreement, unless the change results in the Enrollee becoming ineligible for Medicaid Advantage enrollment as described in Section 5 of this Agreement;
ii) any of the factors listed in Section 33 (Non-Discrimination) of this Agreement; or
iii) the Capitation Rate payable to the Contractor.
Disenrollment Prohibitions. Disenrollment shall not be based in whole or in part on any of the following reasons:
a) an existing condition or a change in the Enrollee's health.
b) any of the factors listed in Section 34 of this Agreement; or
c) on the Capitation Rate payable to the Contractor related to the Enrollee's participation with the Contractor.