Disenrollment Requests For Cause Clause Samples

The "Disenrollment Requests For Cause" clause defines the conditions and procedures under which a party may request to remove an individual or entity from a program, plan, or agreement due to specific, justified reasons. Typically, this clause outlines what constitutes "cause"—such as violations of terms, fraud, or failure to meet obligations—and describes the process for submitting and reviewing such requests, including required documentation and timelines. Its core function is to provide a structured and fair mechanism for addressing serious breaches or issues, thereby protecting the integrity of the arrangement and ensuring that only qualified or compliant participants remain involved.
Disenrollment Requests For Cause. A Member may request Disenrollment from the CONTRACTOR’s health plan for cause at any time. 3.12.1.4.1. The following are considered acceptable for-cause Disenrollments: 3.12.1.4.1.1. Change in Member Residence The Member moves out of the CONTRACTOR’s Service Area, 3.12.1.4.1.2. Contract Termination The CONTRACTOR or the Department has terminated the contract, 3.12.1.4.1.3. The member is in need of related services (for example, a Cesarean Section and a tubal ligation) to be performed at the same time; not all related services are available within the Provider network; and the Enrollee's primary care Provider or another Provider determines that receiving the services separately would subject the Enrollee to unnecessary risk. 3.12.1.4.1.4. For members that use Managed Long Term Care Support Services (MLTSS), the Enrollee would have to change their residential, institutional, or employment supports Provider based on that Provider's change in status from an in-network to an out-of-network Provider with the CONTRACTOR. 3.12.1.4.1.5. Members may Disenroll without cause if the Plan does not, because of moral or religious objections, cover the service the Enrollee seeks.
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Disenrollment Requests For Cause. A Member may request Disenrollment from the CONTRACTOR’s Health Plan for cause at any time as described in42 CFR § 438.56(d)(2). 3.11.1.4.1 The following are considered acceptable for-cause Disenrollments: 3.11.1.4.1.1 Change in Member Residence The Member moves out of the CONTRACTOR’s Service Area,
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Related to Disenrollment Requests For Cause

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

  • Contractor Selection Justification Form Customers shall complete this Contractor Selection Justification Form for each candidate selected and attach all completed forms to the purchase order. Date: Contractor’s Name: _ Contractor’s Contact Information: Address: _ Phone: _ Email: Candidate’s Name: _ Date Candidate will be available: _ Hourly rate of candidate: $ Position candidate recommended for: _ Justification for selection of candidate: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Agency: Division/Section/Unit: _ Printed Name: _ Title: _ Signature _ Date: Contractor's Name: Quarter: Purchase Order (PO) Number: PO Total $ Amount: PO Starting Date Ending Date Please review the attached Rating Definitions and provide your opinion by rating the following: