Enrollment and Disenrollment Updates Clause Samples

The "Enrollment and Disenrollment Updates" clause outlines the procedures and requirements for notifying relevant parties about changes in enrollment status, such as when individuals join or leave a program or plan. Typically, this clause specifies the timeframe within which updates must be reported, the method of communication, and the types of information that must be provided, such as participant names or effective dates. Its core function is to ensure accurate and timely record-keeping, which helps prevent coverage gaps, billing errors, or administrative confusion.
Enrollment and Disenrollment Updates. EOHHS will provide the contractor with a daily update file of all members to be enrolled into RIte Care. The Contractor agrees to have written policies and procedures for receiving these updates and incorporating them into its management information system. EOHHS will provide the Contractor with a monthly full roster of all members enrolled into Rhody Health Partners. This roster will be sent to the Contractor during the first financial cycle of each month, per a schedule supplied by EOHHS. The Contractor agrees to have written policies and procedures for receiving these updates and incorporating them into its management information system.
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Enrollment and Disenrollment Updates. The State shall provide the Contractor with a monthly full roster of all members enrolled. EOHHS will send the roster to the Contractor during the second financial cycle of each month. Contractor agrees to have written policies and procedures for receiving these updates and incorporating them into its management information system.
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Enrollment and Disenrollment Updates. The State shall provide the Contractor with a monthly full roster of all members enrolled into Rhody Health Options. EOHHS will send the roster to the Contractor during the first financial cycle of each month. Contractor agrees to have written policies and procedures for receiving these updates and incorporating them into its management information system.
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Enrollment and Disenrollment Updates. 2.4.14.1 LDH’s enrollment broker shall notify each MCO at specified times each month of the Medicaid beneficiaries that are enrolled, re-enrolled, or disenrolled from their MCO for the following month. The MCO shall receive this notification through the ASC X12N 834 Benefit Enrollment and Maintenance electronic transaction, or in instances of corrections to closed segments, the MCO shall receive this notification through a manual correction processing file. 2.4.14.2 LDH shall use its best efforts to ensure that the Contractor receives timely and accurate enrollment and disenrollment information. In the event of discrepancies or irreconcilable differences between LDH and the Contractor regarding enrollment, disenrollment and/or termination, LDH’s decision is final.
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Enrollment and Disenrollment Updates 
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Related to Enrollment and Disenrollment Updates

  • 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.

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

  • 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.

  • Open Enrollment Period Open Enrollment is a period of time each year when you and your eligible dependents, if family coverage is offered, may enroll for healthcare coverage or make changes to your existing healthcare coverage. The effective date will be on the first day of your employer’s plan year. A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health coverage. You and your eligible dependents may enroll for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days of the following events: • you get married, the coverage effective is the first day of the month following your marriage. • you have a child born to the family, the coverage effective date is the date of birth. • you have a child placed for adoption with your family, the coverage effective date is the date of placement. Special note about enrolling your newborn child: You must notify your employer of the birth of a newborn child and pay the required premium within thirty -one (31) days of the date of birth. Otherwise, the newborn will not be covered beyond the thirty -one (31) day period. This plan does not cover services for a newborn child who remains hospitalized after thirty-one (31) days and has not been enrolled in this plan. If you are enrolled in an Individual Plan when your child is born, the coverage for thirty- one (31) days described above means your plan becomes a Family Plan for as long as your child is covered. Applicable Family Plan deductibles and maximum out-of-pocket expenses may apply. In addition, if you lose coverage from another plan, you may enroll or add your eligible dependents for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days following the date you lost coverage. Coverage will begin on the first day of the month following the date your coverage under the other plan ended. In order to be eligible, the loss of coverage must be the result of: • legal separation or divorce; • death of the covered policy holder; • termination of employment or reduction in the number of hours of employment; • the covered policy holder becomes entitled to Medicare; • loss of dependent child status under the plan; • employer contributions to such coverage are being terminated; • COBRA benefits are exhausted; or • your employer is undergoing Chapter 11 proceedings. You are also eligible for a Special Enrollment Period if you and/or your eligible dependent lose eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), or if you and/or your eligible dependent become eligible for premium assistance for Medicaid or a (CHIP). In order to enroll, you must provide required information within sixty (60) days following the change in eligibility. Coverage will begin on the first day of the month following our receipt of your application. In addition, you may be eligible for a Special Enrollment Period if you provide required information within thirty (30) days of one of the following events: • you or your dependent lose minimum essential coverage (unless that loss of coverage is due to non-payment of premium or your voluntary termination of coverage); • you adequately demonstrate to us that another health plan substantially violated a material provision of its contract with you; • you make a permanent move to Rhode Island: or • your enrollment or non-enrollment in a qualified health plan is unintentional, inadvertent, or erroneous and is the result of error, misrepresentation, or inaction by us or an agent of HSRI or the U.S. Department of Health and Human Services (HHS).