Common use of Enrollment Clause in Contracts

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will accept all Dual Eligible individuals who select the MA Dual SNP’s MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will submit the enrollment file no earlier than the first business day and no later than 20 calendar days following the expiration of a 3-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system and CMS enrollment information, and return the validated enrollment information to MA Dual SNP by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP must submit the January 2021 enrollment file no earlier than May 1, 2021 (the first business day of the month following a 3-month lag period) and no later than May 20, 2021. HHSC will return validated enrollment information to the MA Dual SNP no later than June 7, 2021 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNP: (1) will lose the opportunity to receive the per member per month capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will accept all Dual Eligible individuals Eligibles who select the MA Dual SNP’s MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will submit the enrollment file no earlier than the first business day and no later than 20 twenty (20) calendar days following the expiration of a 3-month three (3)-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s El eligibility system and CMS enrollment information, information and return the validated enrollment information to MA Dual SNP by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP must submit the January 2021 2023 enrollment file no earlier than May 1, 2021 2023 (the first business day of the month following a 3three-month lag period) and no later than May 20, 20212023. HHSC will return validated enrollment information to the MA Dual SNP no later than June 7, 2021 2023 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNP: (1) will lose the opportunity to receive the per member per month capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will accept all Dual Eligible individuals who select the MA Dual SNP’s MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will submit the enrollment file no earlier than the first business day and no later than 20 calendar days following the expiration of a 3-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system and CMS enrollment information, and return the validated enrollment information to MA Dual SNP by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP must submit the January 2021 2020 enrollment file no earlier than May 1, 2021 2020 (the first business day of the month following a 3-month lag period) and no later than May 20, 20212020. HHSC will return validated enrollment information to the MA Dual SNP no later than June 7, 2021 2020 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNP: (1) will lose the opportunity to receive the per member per per-member-per-month (“PMPM”) capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will accept all Dual Eligible individuals Eligibles who select the MA Dual SNP’s MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will submit the enrollment file no earlier than the first business day Business Day and no later than 20 twenty (20) calendar days following the expiration of a 3-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s three (3)- eligibility system and CMS enrollment information, information and return the validated enrollment information to MA Dual SNP by the fifth business day Business Day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP must submit the January 2021 2023 enrollment file no earlier than May 1, 2021 2023 (the first business day Business Day of the month following a 3three-month lag period) and no later than May 20, 20212023. HHSC will return validated enrollment information to the MA Dual SNP no later than June 7, 2021 2023 (the fifth business day Business Day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNP: (1) will lose the opportunity to receive the per member per month capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will Health Plan must accept all Dual Eligible individuals who select the MA Dual SNP’s Health Plan's MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will must not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will Health Plan must provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will Health Plan must submit the enrollment file no earlier than the first business day and no later than 20 calendar days following the expiration of a 3-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system and CMS enrollment information, information and return the validated enrollment information to the MA Dual SNP Health Plan by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP Health Plan must submit the January 2021 enrollment file no earlier than May 1, 2021 (the first business day of the month following a 3-month lag periodmonth) and no later than May 20, 2021. HHSC will return validated enrollment information to the MA Dual SNP Health Plan no later than June 7, 2021 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNPHealth Plan: (1) will lose the opportunity to receive the per member per month (PMPM) capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will Health Plan must accept all Dual Eligible individuals Eligibles who select the MA Dual SNP’s Health Plan's MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will must not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will Health Plan must provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will Health Plan must submit the enrollment file no earlier than the first business day and no later than 20 twenty (20) calendar days following the expiration of a 3-month three (3)-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system w and CMS enrollment information, information and return the validated enrollment information to the MA Dual SNP Health Plan by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP Health Plan must submit the January 2021 enrollment file no earlier than May 1, 2021 (the first business day of the month following a 3three-month lag period) and no later than May 20, 2021. HHSC will return validated enrollment information to the MA Dual SNP Health Plan no later than June 7, 2021 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNPHealth Plan: (1) will lose the opportunity to receive the per member per month (PMPM) capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will Health Plan must accept all Dual Eligible individuals Eligibles who select the MA Dual SNP’s Health Plan's MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will must not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will Health Plan must provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will Health Plan must submit the enrollment file no earlier than the first business day and no later than 20 twenty (20) calendar days following the expiration of a 3-month three (3)-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system and CMS enrollment information, information and return the validated enrollment information to the MA Dual SNP Health Plan by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP Health Plan must submit the January 2021 2022 enrollment file no earlier than May 1, 2021 2022 (the first business day of the month following a 3three-month lag period) and no later than May 20, 20212022. HHSC will return validated enrollment information to the MA Dual SNP Health Plan no later than June 7, 2021 2022 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNPHealth Plan: (1) will lose the opportunity to receive the per member per month (PMPM) capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP Health Plan will accept all Dual Eligible individuals who select the MA Dual SNP’s Health Plan's MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP Health Plan will provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP Health Plan will submit the enrollment file no earlier than the first business day and no later than 20 calendar days following the expiration of a 3-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system and CMS enrollment information, and return the validated enrollment information to the MA Dual SNP Health Plan by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP Health Plan must submit the January 2021 2020 enrollment file no earlier than May 1, 2021 2020 (the first business day of the month following a 3-month lag periodmonth) and no later than May 20, 20212020. HHSC will return validated enrollment information to the MA Dual SNP Health Plan no later than June 7, 2021 2020 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNPHealth Plan: (1) will lose the opportunity to receive the per member per per-member-per-month (“PMPM”) capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will accept all Dual Eligible individuals Eligibles who select the MA Dual SNP’s MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will submit the enrollment file no earlier than the first business day Business Day and no later than 20 twenty (20) calendar days following the expiration of a 3-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s three (3)- eligibility system and CMS enrollment information, information and return the validated enrollment information to MA Dual SNP by the fifth business day Business Day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP must submit the January 2021 2023 enrollment file no earlier than May 1, 2021 2023 (the first business day Business Day of the month following a 3three-month lag period) and no later than May 20, 20212023. HHSC will return validated enrollment information to the MA Dual SNP no later than June 7, 2021 2023 (the fifth business day Business Day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNP: (1) will lose the opportunity to receive the per member per month capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will Health Plan must accept all Dual Eligible individuals Eligibles who select the MA Dual SNP’s Health Plan's MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will must not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will Health Plan must provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will Health Plan must submit the enrollment file no earlier than the first business day and no later than 20 twenty (20) calendar days following the expiration of a 3-month three (3)-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system and CMS enrollment information, information and return the validated enrollment information to the MA Dual SNP Health Plan by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP Health Plan must submit the January 2021 202 enrollment file no earlier than May 1, 2021 202 (the first business day of the month following a 3three-month lag period) and no later than May 20, 2021202 . HHSC will return validated enrollment information to the MA Dual SNP Health Plan no later than June 7, 2021 202 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNPHealth Plan: (1) will lose the opportunity to receive the per member per month (PMPM) capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.

Enrollment. (a) Unless a Dual Eligible is otherwise not eligible to enroll in the MA Product under federal Medicare Advantage plan rules, the MA Dual SNP will Health Plan must accept all Dual Eligible individuals Eligibles who select the MA Dual SNP’s Health Plan's MA Product without regard to physical or mental condition, health status or need for or receipt of healthcare services, claims experience, medical history, genetic information, disability, marital status, age, sex, national origin, race, color, or religion, and will must not use any policy or practice that has the effect of such discrimination. (b) MA Dual SNP will Health Plan must provide enrollment files of Dual Eligible Members and Other Dual SNP Members covering monthly reporting periods. The files must comply with State formatting requirements. After the conclusion of a monthly reporting period, the MA Dual SNP will Health Plan must submit the enrollment file no earlier than the first business day and no later than 20 twenty (20) calendar days following the expiration of a 3-month three (3)-month lag period. HHSC will then verify eligibility of the Dual Eligible Members with HHSC’s eligibility system and CMS enrollment information, information and return the validated enrollment information to the MA Dual SNP Health Plan by the fifth business day of the month following receipt of the enrollment file. By way of example, the MA Dual SNP Health Plan must submit the January 2021 2022 enrollment file no earlier than May 1, 2021 2022 (the first business day of the month following a 3three-month lag period) and no later than May 20, 20212022. HHSC will return validated enrollment information to the MA Dual SNP Health Plan no later than June 7, 2021 2022 (the fifth business day of the following month). If the enrollment file does not include a Dual Eligible Member by the 20th calendar day deadline, the MA Dual SNPHealth Plan: (1) will lose the opportunity to receive the per member per month (PMPM) capitation payment for such Dual Eligible Member for the reporting period, and (2) will be responsible for all Cost Sharing Obligations for such Dual Eligible Member for the reporting period.