Common use of Excluded Populations Clause in Contracts

Excluded Populations. The following Eligibles will be excluded from enrollment in SoonerSelect Dental: • Dual Eligible Individuals; • Individuals enrolled in the Medicare Savings Program, including Qualified Medicare Beneficiaries (QMB), Specified Low Income Medicare Beneficiaries (SLMB), Qualified Disabled Workers (QDW) and Qualified Individuals (QI); • Persons with a nursing facility or ICF-IID level of care, with the exception of Dental Health Plan Enrollees with a pending level of care determination. • Individuals during a period of Presumptive Eligibility; • Individuals infected with tuberculosis eligible for tuberculosis-related services under 42 C.F.R. § 435.215; • Individuals determined eligible for SoonerCare on the basis of needing treatment for breast or cervical cancer under 42 C.F.R. § 435.213; • Individuals enrolled in a §1915(c) Waiver; • Undocumented persons eligible for Emergency Services only in accordance with 42 C.F.R. § 435.139; • Insure Oklahoma Employee Sponsored Insurance (ESI) dependent children in accordance with the Oklahoma Title XXI State Plan; • Coverage of Pregnancy-Related Services under Title XXI for the benefit of unborn children (‘Soon- to-be-Sooners’), as allowed by 42 C.F.R. § 457.10; and • Individuals determined eligible for Medicaid on the basis of age, blindness, or disability.