Enrollment and Disenrollment Procedures Sample Clauses

The Enrollment and Disenrollment Procedures clause outlines the steps and requirements for individuals or entities to join or leave a program, service, or plan. It typically details the necessary documentation, deadlines, and any conditions that must be met for enrollment, as well as the process for formally withdrawing or being removed. This clause ensures that all parties understand the formalities involved, thereby promoting transparency and minimizing disputes related to participation status.
Enrollment and Disenrollment Procedures i) Where appropriate, explanation of Lock-In requirements, and initial grace period when person may change plans, or return to fee-for-service in voluntary areas. ii) Choice of PCP (each person can have his/her own PCP and can change thirty (30) days after the initial appointment with their PCP, and once every six months thereafter). iii) Procedures for disenrollment. iv) Opportunities for change v) LDSS/or enrollment broker phone number for information on enrollment and disenrollment. 1) Rights and Responsibilities of Enrollees i) Explanation of what an Enrollee has the right to expect from the Contractor in the way of medical care and treatment of the Enrollee. ii) Responsibilities of the Enrollee (general). iii) Enrollee's financial responsibility for payment when services are furnished by a provider who is not part of the Contractor's network or by any provider without required authorization or when a procedure, treatment, or service is not a covered benefit; also note exceptions such as family planning and HIV counseling/testing. iv) Enrollee's rights under State law to formulate advance directives. v) The manner in which Enrollees may participate in the development of plan policies.
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Enrollment and Disenrollment Procedures i) Where appropriate, explanation of Lock-In requirements, and initial grace period when person may change plans, or return to fee-for-service in voluntary areas. ii) Choice of PCP (each person can have his/her own PCP and can change thirty (30) days after the initial appointment with their PCP, and once every six months thereafter). iii) Procedures for disenrollment. iv) Opportunities for change v) LDSS/or enrollment broker phone number for information on enrollment and disenrollment.
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Enrollment and Disenrollment Procedures i) Where appropriate, explanation of Lock-In requirements, and initial grace period when person may change plans, or return to fee-for-service involuntary areas. ii) Choice of PCP (each person can have his/her own PCP and can change thirty (30) days after the initial appointment with their PCP, and once every six months thereafter). iii) Procedures for disenrollment iv) Opportunities for change v) LDSS/or enrollment broker phone number for information on enrollment and disenrollnent. Rights and Responsibilities of Enrollees i) Explanation of what an Enrollee has the right to expect from the Contractor in the way of medical care and treatment of the Enrollee. ii) Responsibilities of the Enrollee (general). iii) Enrollee's financial responsibility for payment when services are furnished by a provider who is not part of the Contractor's network or by any provider without required authorization or when a procedure, treatment, or service is not a covered benefit; also note exceptions such as family planning and HIV counseling/testing. iv) Enrollee's rights under State law to formulate advance directives. The manner in which Enrollees may participate in the development of plan policies. Language Description of how the Contractor addresses the needs of non-English speaking Enrollees. Grievance Procedures (complaints) i) Right to file a grievance regarding any dispute between the Contractor and an Enrollee. ii) Right to file a grievance orally when the dispute is about referrals or covered benefits. iii) Explanation of who in the plan to call, along with the Contractor's toll-free number. iv) Time frames and circumstances for expedited and standard grievances. APPENDIX E OCTOBER 1, 2004 E-5 v) Right to appeal a grievance determination and the procedures: for filing such, an appeal. vi) Time frames and circumstances for expedited and standard appeals. vii) Right to designate a representative. viii) A notice that all decisions: involving clinical disputes will be made by qualified clinical personnel and that all notices will include information about the basis of the decision, and further appeal rights (if any). ix) medically related complaints (1-800-206-8125). x) New York State Insurance Department numb▇▇ ▇▇▇ ▇▇▇▇▇▇▇ complaints relating to billing: Fair Hearing. Explain that: i) Enrollee has a right to a State Fair Hearing and Aids to CONTINUING in some situations ii) Describe situations when the Enrollee may ask for a fair hearing as described in Section 25 of th...
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Enrollment and Disenrollment Procedures i) Where appropriate, explanation of Lock-In requirements and when an Enrollee may change to another MCO, or for MMC Enrollees if permitted, return to Medicaid fee-for-service, for Good Cause, as defined in Appendix H of this Agreement. ii) Procedures for Disenrollment. iii) LDSS or Enrollment Broker as appropriate phone number for information on Enrollment and Disenrollment.
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Enrollment and Disenrollment Procedures i) Where appropriate, explanation of Lock-In requirements and when an Enrollee may change to another MCO, or for MMC Enrollees if permitted, return to Medicaid fee-for-service, for Good Cause, as defined in Appendix H of this Agreement. ii) Procedures for Disenrollment. iii) LDSS, or Enrollment Broker as appropriate, phone number for information on Enrollment and Disenrollment. 1) Rights and Responsibilities of Enrollees i) Explanation of what an Enrollee has the right to expect from the Contractor in the way of medical care and treatment of the Enrollee as specified in Section 13.7 of this Agreement. ii) General responsibilities of the Enrollee. iii) Enrollee's potential financial responsibility for payment when services are furnished by a Non-Participating Provider or are famished by any provider without required authorization, or when a procedure, treatment, or service is not a covered benefit. Also note exceptions such as family planning and HIV counseling/testing. APPENDIX E October 1, 2005 iv) Enrollee's rights under State law to formulate advance directives. v) The manner in which Enrollees may participate in the development of Contractor policies.
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Related to Enrollment and Disenrollment Procedures

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department shall advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor shall be bound by the changes in enrollment procedures.

  • 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.‌

  • 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:

  • Election Procedures (a) Each record holder of Shares (other than Dissenting Shares, if any, Shares owned by Textron and shares to be cancelled in accordance with Section 3.1(b)) issued and outstanding immediately prior to the Effective Time shall be entitled to submit a request specifying the portion of such record holder's Shares which such record holder desires to have converted into (i) the Cash Consideration (a "Cash Election"), (ii) the Stock Consideration (a "Stock Election") or (iii) the Mixed Consideration (a "Mixed Election"), or to indicate that such record holder has no preference as to the receipt of Cash Consideration, Stock Consideration or Mixed Consideration for such Shares (a "Non-Election"). Shares in respect of which a Non-Election is made (including Shares in respect of which such an election is deemed to have been made pursuant to this Section 3.2(a) and Section 3.1(g)) (collectively, "Non-Election Shares") shall be deemed to be Shares in respect of which a Cash Election has been made. (b) Elections pursuant to Section 3.2(a) shall be made on the form of letter of transmittal and form of election (the "Letter of Transmittal and Form of Election") to be provided by the Paying Agent (as defined in Section 3.3(a)) to holders of record of Shares, together with instructions for use in effecting the surrender of the Certificates for payment therefor, as soon as practicable following the Effective Time. The Letter of Transmittal and Form of Election shall specify that delivery shall be effected, and risk of loss and title to the Certificates transmitted therewith shall pass, only upon proper delivery of the Certificates to the Paying Agent. Elections shall be made by mailing to the Paying Agent a duly completed Letter of Transmittal and Form of Election in accordance with Section 3.3(b). To be effective, a Letter of Transmittal and Form of Election must be (i) properly completed, signed and submitted to the Paying Agent at its designated office and (ii) accompanied by the Certificates representing the Shares as to which the election is being made (or by an appropriate guarantee of delivery of such Certificates by a commercial bank or trust company in the United States or a member of a registered national security exchange or of the National Association of Securities Dealers, Inc., provided such Certificates are in fact delivered to the Paying Agent within eight Trading Days after the date of execution of such guarantee of delivery). The Company shall determine, in its sole and absolute discretion, which authority it may delegate in whole or in part to the Paying Agent, whether any Letter of Transmittal and Form of Election has been properly completed, signed and submitted or revoked. The decision of the Company (or the Paying Agent, as the case may be) in such matters shall be conclusive and binding. Neither the Company nor the Paying Agent will be under any obligation to notify any person of any defect in a Letter of Transmittal and Form of Election submitted to the Paying Agent.

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