ENROLLMENT PROCESSING Sample Clauses

ENROLLMENT PROCESSING. 2.4.6.1.1. Enrollment and disenrollment shall be processed through the One Care Plan, consistent with the Effective Enrollment Date requirements outlined in Section 2.4.6.2, and the requirements for marketing, education, and enrollment activities described in Section 2.12.1. 2.4.6.1.2. At EOHHS’s discretion, EOHHS may require the Contractor to opt into the Medicare Online Enrollment Center (OEC) to receive Medicare Enrollment and Disenrollment requests for its One Care Plan; upon such direction from EOHHS, the Contractor shall opt in and maintain participation in the OEC throughout the Contract Term. 2.4.6.1.3. The Contractor shall: 2.4.6.1.3.1. Have a mechanism for sending and receiving timely information about all Enrollees, including confirmation of the Effective Enrollment Date, from CMS and MassHealth systems; 2.4.6.1.3.2. Submit enrollment requests to EOHHS via the Provider Online Service Center on behalf of MassHealth Members eligible for, and seeking to enroll in, the Contractor’s One Care Plan; 2.4.6.1.3.3. Submit and receive aligned enrollment transactions to CMS or its designee for Medicare coverage through the Contractor’s One Care Plan, in accordance with CMS requirements; 2.4.6.1.3.4. Maintain aligned Medicare and Medicaid enrollments in the Contractor’s One Care Plan; 2.4.6.1.3.5. On each business day, obtain from EOHHS, the daily and monthly (as available) via the HIPAA 834 Enrollment Files, and process information pertaining to all enrollments in the Contractor’s Plan, including the Effective Date of Enrollment; 2.4.6.1.3.6. The Contractor’s internal enrollment system shall be configured to automatically ingest these files and use them for the following purposes:

ENROLLMENT PROCESSING. New enrollment of Participating Accounts --------------------- and Eligible Employees by NMS shall cease on a date to be determined by THE ASSOCIATION but in no event later than the effective date of the termination. Any Enrollment Forms received by NMS subsequent to such date shall be sent to THE ASSOCIATION via facsimile and first-class mail within two (2) Business Days of receipt.

ENROLLMENT PROCESSING a) Processing: NMS shall process completed Enrollment Forms within three (3) business days of receipt. NMS will contact the GECS business for clarification of all forms that are not properly completed and NMS cannot determine the correct information. The GECS business unit will provide NMS with corrected information within three business days. NMS win process all corrections within one (1) business day of receipt.

ENROLLMENT PROCESSING. F.1 PERFORMANCE STANDARD 1: Provide the State of Wisconsin employees with a Confirmation Notice of enrollment or re-enrollment in benefit plans. F.1.A. PERFORMANCE GUARANTEE 1(A): Confirmation Notices of enrollment or re-enrollment in the ERA plan will be produced and mailed to employees within ten (10) business days from the benefit posting. PENALTY 1(A): FBMC will incur a penalty of $ 10.00 per participant Confirmation Notice for failure to meet this guarantee. FUNCTIONAL TEAM ASSIGNED: Benefits Notification

ENROLLMENT PROCESSING. 2.4.6.1.1. Enrollment and disenrollment shall be processed through the SCO Plan, consistent with the Effective Enrollment Date requirements outlined in Section 2.4. 6.2.1. 1, and the requirements for marketing, education, and enrollment activities described in Section 2.12.1. 2.4.6.1.2. The Contractor shall opt into the Medicare Online Enrollment Center (OEC) to receive Medicare Enrollment and Disenrollment requests for its SCO Plan and shall maintain participation in the OEC throughout the Contract Term. 2.4.6.1.3. The Contractor shall: 2.4.6.1.3.1. Have a mechanism for sending and receiving timely information about all Enrollees into the Contractor’s SCO Plan, including confirmation of the Effective Enrollment Date, from CMS and MassHealth systems. 2.4.6.1.3.2. Submit enrollment requests to EOHHS on behalf of MassHealth Members eligible for, and seeking to enroll in, the Contractor’s SCO Plan. 2.4.6.1.3.3. Submit and receive aligned enrollment transactions to CMS or its designee for Medicare coverage through the Contractor’s SCO Plan, in accordance with CMS requirements. 2.4.6.1.3.4. On each business day, obtain from EOHHS, via the HIPAA 834 Enrollment File, and process information pertaining to all enrollments in the Contractor’s Plan, including the Effective Date of Enrollment.

ENROLLMENT PROCESSING. A. An enrollment shall be deemed to take place when [***]. Notwithstanding the foregoing, no Cardholder’s oral or written agreement to enroll will be deemed to be complete and effective until [***]. Purchaser shall [***] and where allowed by law, shall provide such evidence to Sears upon [***] business days’ request. B. Charges for Additional Financial Product membership fees [***]. C. Purchaser shall ensure that [***], unless otherwise required by law or agreed to by Sears: provided, however, that [***]. Purchaser shall ensure that appropriate MIS reports are prepared periodically. in accordance with the requirement set forth in Attachment A to the Amendment to [***].

ENROLLMENT PROCESSING. 3.1 TOP Prime and TOP Prime Remote are available to Service members and certain ADFMs in overseas locations as described below. These programs are similar, but not identical, to TRICARE Prime and TRICARE Prime Remote (TPR)/TRICARE Prime Remote for ADFMs (TPRADFMs) in the U.S. TOP Prime enrollees shall normally be enrolled to a Military Treatment Facility (MTF) Primary Care Manager (PCM), but enrollment to a purchased care sector PCM may be authorized when MTF capacity is reached. TOP Prime enrollment procedures shall be established in the Statements of Responsibilities (SORs) between the TOP contractor and the MTF Commander. TOP Prime Remote enrollees shall be enrolled to a remote Defense Medical Information System (DMIS) code with assignment to a purchased care sector PCM or to the TOP contractor, according to the specific regional enrollment procedures established in the SORs between the contractor and the TRICARE Area Office (TAO) Directors. 3.2 Unless a specific exception exists, enrollment to TOP Prime or TOP Prime Remote is available only to Service members who are permanently assigned overseas, and to ADFMs who are Command Sponsored and accompanying their sponsor on his/her overseas tour, or on orders in an overseas location (see paragraph 5.1 for additional information regarding Command Sponsorship). This includes activated Reserve Component (RC) Service members who are on orders to an overseas location for more than 30 days, and their Command Sponsored ADFMs who accompany the RC member on his/her overseas tour or are on orders in an overseas location. See paragraph 5.0 for additional details on family member eligibility. 3.3 Non-Command Sponsored ADFMs, retirees, and retiree family members are not eligible for TOP Prime or TOP Prime Remote enrollment in any overseas location. ADFMs who are not Command Sponsored or on military orders as described in this section will be covered by TOP Standard (see Section 19). 3.4 Enrollment may occur at any time after TOP eligibility has been established, and normally remains effective during the overseas tour of the sponsor. Annual re-enrollment is not required for TOP Prime or TOP Prime Remote. Once enrolled, beneficiaries remain enrolled in these programs until: • The 61st calendar day following the end of the overseas tour (see paragraph 11.5). 3.5 The TOP contractor shall perform all enrollment-related activities for TOP Prime, TOP Prime Remote, TRICARE Plus, TRICARE Young Adult (TYA), TRICARE Reserve Select...

ENROLLMENT PROCESSING. Notwithstanding Section 3.1 or any other provision of this Contract, if DHS fails to cure a noncompliance with Section 4.4, Enrollment Processing, within the Cure Period, DHS will be financially liable for such noncompliance as follows: DHS will be financially liable for Contractor's demonstrated actual reasonable losses as a result of the noncompliance, beginning with DHS' first failure to comply with its enrollment obligation set forth herein. DHS' financial liability shall not exceed 15 percent of Contractor's monthly capitation payment calculated as if noncompliance with Section 4.4 did not occur, for each month in which DHS has not cured noncompliance pursuant to subparagraph 4.4.4.B, beginning with DHS' first failure to comply with its enrollment obligation set forth herein. ▇▇▇▇▇▇ MEDICAL CENTERS, INC. 95-23637-A03

ENROLLMENT PROCESSING. Review applications for Enrollment submitted timely by the Enrollment Contractor, and check the eligibility of applicants for services under this Contract. For those applications for Enrollment received prior to the specified deadlines, DHS will provide to the Contractor a list of Members on a monthly basis, effective the first of the following month. Those applications for Enrollment received after the specified submission deadlines will become effective the first day of the second month following the receipt of the late application. ▇▇▇▇▇▇ Medical Centers 95-23637 Article IV