Enrollment of Members with a Contractor Clause Samples

Enrollment of Members with a Contractor. As part of the application process for coverage under CHIP, a Member shall select a Contractor. Members will have thirty (30) calendar days to select a Contractor. Members who fail to make a voluntary Contractor selection will be subject to Auto Enrollment with a Contractor by the Division. Auto Enrollment rules will include provisions to consider the following in the order listed below:
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Enrollment of Members with a Contractor. A Member shall have thirty (30) Calendar Days to select a Contractor and a PCP. Members who fail to make a voluntary Contractor selection within thirty (30) calendar days of their Enrollment will be auto enrolled to a Contractor by the Division. Auto-assignment rules will include provisions to: 1. Determine whether the Member was previously enrolled with a Contractor within the previous sixty (60) calendar days; and assign Member to that Contractor; 2. Determine whether an immediate family member is assigned to a Contractor and assign the Member to that Contractor; 3. Review paid claims data within the past six (6) months and assign Member to the Contractor that has a contract with a PCP with whom the Member has a history in the last six (6) months; and 4. If no previous assignment within sixty (60) days; and no immediate family members already enrolled, of if the Member does not have a prior history with a PCP, then assign the Member to Contractor with a PCP closest to Member’s home address. 5. If multiple Contractors meet this standard, then assignment will occur using a random process. The Division reserves the right to modify the Enrollment and Auto Enrollment rules at its discretion. The Division may, at its discretion, set and make subsequent changes to a threshold for the percentage of Members who can be enrolled with a single Contractor. Members will not be auto enrolled to a Contractor that exceeds this threshold unless a family member is enrolled in the Contractor or a historical Provider relationship exists with a Provider that does not participate in any other Contractor. The Division will provide the Contractors with a minimum of fourteen (14) days advance notice in writing when changing the threshold percentage. Beneficiaries already enrolled with a Contractor are given priority to continue that enrollment if the Contractor entity does not have the capacity to accept all those seeking enrollment under the program. The Division will notify Members and the Contractor within five (5) business days of the selection or Auto Enrollment. The Division’s notice to the Member will be made in writing and sent via surface mail. Notice to the Contractor will be made via the Member Listing Report.
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Related to Enrollment of Members with a Contractor

  • 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.‌

  • Restricted Employment for Certain State Personnel Contractor acknowledges that, pursuant to Section 572.069 of the Texas Government Code, a former state officer or employee of a state agency who during the period of state service or employment participated on behalf of a state agency in a procurement or contract negotiation involving Contractor may not accept employment from Contractor before the second anniversary of the date the Contract is signed or the procurement is terminated or withdrawn.

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

  • Eligible Employee For purposes of the SIMPLE 401(k) Plan provisions, any Employee who is entitled to make Elective Deferrals under the terms of the SIMPLE 401(k) Plan.

  • Developer Compensation for Emergency Services If, during an Emergency State, the Developer provides services at the request or direction of the NYISO or Connecting Transmission Owner, the Developer will be compensated for such services in accordance with the NYISO Services Tariff.