General Enrollment Sample Clauses

The General Enrollment clause outlines the basic requirements and procedures for individuals or entities to enroll in a program, service, or plan. Typically, it specifies eligibility criteria, necessary documentation, and the process for submitting an application or registration. For example, it may require applicants to provide identification, complete certain forms, or meet age or residency requirements. The core function of this clause is to establish clear and consistent guidelines for participation, ensuring that only qualified individuals are admitted and that the enrollment process is transparent and orderly.
General Enrollment. 2.3.1.1. Contractor shall accept all eligible beneficiaries as defined in Appendix J – Eligible Populations. 2.3.1.2. Eligible beneficiaries residing within the Contractor Service Area may be enrolled at any time up to six (6) months prior to the end of the Demonstration. Eligible beneficiaries shall be accepted by Contractor in the order in which they apply without regard to race, color, national origin, creed, ancestry, religion, language, age, gender, marital status, sexual orientation, health status, need for health care services or disability. 2.3.1.3. Enrollee coverage shall begin at 12:01 a.m. on the first day of the calendar month for which the eligible beneficiary's name is added to the approved list of Enrollees furnished by CMS and the DHCS Enrollment Broker. The term of enrollment shall continue unless this Contract expires, is terminated, or the Enrollee is disenrolled under the conditions described in Section 2.3.2, Disenrollment. 2.3.1.4. Enrollment will proceed unless restricted by CMS or the Sstate. Such restrictions will be defined in writing by CMS or the Sstate and the Contractor notified at least ten (10) calendar days prior to the start of the period of restriction. Release of restrictions will be in writing and transmitted to the Contractor at least ten (10) days calendar prior to the date of the release.
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General Enrollment. 2.3.1.1. Contractor shall accept all eligible beneficiaries as defined in Appendix J – Eligible Populations. 2.3.1.2. Eligible beneficiaries residing within the Contractor Service Area may be enrolled at any time up to six (6) months prior to the end of the Demonstration. Eligible beneficiaries shall be accepted by Contractor in the order in which they apply without regard to race, color, national origin, creed, ancestry, religion, language, age, gender, marital status, sexual orientation, health status, or disability. 2.3.1.3. Enrollee coverage shall begin at 12:01 a.m. on the first day of the calendar month for which the eligible beneficiary's name is added to the approved list of Enrollees furnished by CMS and the DHCS Enrollment Broker. The term of enrollment shall continue unless this Contract expires, is terminated, or the Enrollee is disenrolled under the conditions described in Section 2.3.2, Disenrollment. 2.3.1.4. Enrollment will proceed unless restricted by CMS or the state. Such restrictions will be defined in writing by CMS or the state and the Contractor notified at least ten (10) calendar days prior to the start of the period of restriction. Release of restrictions will be in writing and transmitted to the Contractor at least ten (10) days calendar prior to the date of the release.
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General Enrollment. 2.3.3.1. DMAS will begin opt-in Enrollment prior to the initiation of Passive Enrollment. During this period, Eligible Beneficiaries may choose to enroll into a particular MMP. Eligible Beneficiaries who do not select a MMP or who do not opt out of the Demonstration will be assigned to a MMP during Passive Enrollment.
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General Enrollment. All Enrollment effective dates are prospective. Enrollee -elected Enrollment is effective the first calendar day of the month following the initial receipt of an Enrollee’s request to enroll, or the first day of the month following the month in which the Enrollee is eligible, as applicable for an individual Enrollee. MDCH will conduct phased in periods for Opt In and Passive Enrollment.
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General Enrollment. Contractor shall accept all eligible beneficiaries as defined in Appendix J – Eligible Populations.
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General Enrollment. Participant’s enrollment in the Ecosystem Program is subject to acceptance by GED. Once accepted, Participant will be provided access to the Ecosystem Community. Participant may only participate in the Ecosystem Program under the terms and conditions of Program Guide and this Agreement. The Program Guide may define benefits and qualification criteria (including any minimum attainment thresholds) for certain tiers of partners and Participant will only be entitled to the benefits for which Participant has achieved qualification criteria and/or paid any applicable fees specified in the Program Guide. GED or its Affiliates may from time to time use the contact details provided by Participant to contact Participant in connection with the Ecosystem Program. If GED permits Participant to provide customer referrals through the Ecosystem Community, Participant understands and agrees that GE will not be obligated to pay any referral fee or other compensation to Participant for such referrals unless otherwise expressly provided in the Program Guide.
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General Enrollment. All Enrollment effective dates are prospective. Enrollee -elected Enrollment is effective the first calendar day of the month following the initial receipt of an Enrollee’s request to enroll if received prior to the Card Cut Off Date, or the first day of the month following the month in which the Enrollee is eligible, as applicable for an individual Enrollee. MDHHS will conduct phased in periods for Opt In and Passive Enrollment. The Enrollment Broker will provide customer service, including mechanisms to counsel Enrollees notified of Passive Enrollment and to receive and communicate Enrollee choice to disenroll or Opt Out to CMS on a daily basis via transactions to CMS’ Medicare Advantage Prescription Drug (▇▇▇▇) Enrollment system. Enrollees will also be provided a notice upon the completion of the disenrollment or Opt Out process. The Michigan Medicare-Medicaid Assistance Program (MMAP) will provide eligible individuals, family members, and other stakeholders’ direct outreach and education presentations, and maintain on-going capacity for outreach, education and individualized plan counseling. The MMAP will build upon its partnership with Michigan’s Area Agencies on Aging and work with other information and assistance providers, such as senior centers, and Centers for Independent Living. Medicare resources, including 1-800-Medicare, will remain a resource for Medicare beneficiaries; calls related to Demonstration Enrollment will be referred to the Michigan Enrollment Broker for customer service and Enrollment support. Opt In Enrollment Aging and Disability Resource Collaboratives (ADRCs) will provide outreach and options counseling when they are deemed ready in the Demonstration Service Areas.
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General Enrollment. Participant may apply to the Alliance Program by submitting the application on this Web site. By submitting an application, Participant agrees to be bound by this Agreement in the event that Participant is accepted by GE. GE may from time to time use the contact details provided by Participant to contact Participant in connection with the Alliance Program. GE will review Participant’s application for completeness and notify Participant if additional information is required. GE reserves the right to accept or reject any application in its sole discretion. If GE accepts Participant’s application, then Participant shall be notified and provided with instructions for general enrollment and access to the Alliance Community.
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Related to General Enrollment

  • Special Enrollment a. KFHPWA will allow special enrollment for persons: 1) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and have had such other coverage terminated due to one of the following events: • Cessation of employer contributions. • Exhaustion of COBRA continuation coverage. • Loss of eligibility, except for loss of eligibility for cause. 2) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and who have had such other coverage exhausted because such person reached a lifetime maximum limit. KFHPWA or the Group may require confirmation that when initially offered coverage such persons submitted a written statement declining because of other coverage. Application for coverage must be made within 31 days of the termination of previous coverage. b. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents (other than for nonpayment or fraud) in the event one of the following occurs: 1) Divorce or Legal Separation. Application for coverage must be made within 60 days of the divorce/separation. 2) Cessation of Dependent status (reaches maximum age). Application for coverage must be made within 30 days of the cessation of Dependent status. 3) Death of an employee under whose coverage they were a Dependent. Application for coverage must be made within 30 days of the death of an employee. 4) Termination or reduction in the number of hours worked. Application for coverage must be made within 30 days of the termination or reduction in number of hours worked. 5) Leaving the service area of a former plan. Application for coverage must be made within 30 days of leaving the service area of a former plan. 6) Discontinuation of a former plan. Application for coverage must be made within 30 days of the discontinuation of a former plan. c. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents in the event one of the following occurs: 1) Marriage. Application for coverage must be made within 31 days of the date of marriage. 2) Birth. Application for coverage for the Subscriber and Dependents other than the newborn child must be made within 60 days of the date of birth. 3) Adoption or placement for adoption. Application for coverage for the Subscriber and Dependents other than the adopted child must be made within 60 days of the adoption or placement for adoption. 4) Eligibility for premium assistance from Medicaid or a state Children’s Health Insurance Program (CHIP), provided such person is otherwise eligible for coverage under this EOC. The request for special enrollment must be made within 60 days of eligibility for such premium assistance. 5) Coverage under a Medicaid or CHIP plan is terminated as a result of loss of eligibility for such coverage. Application for coverage must be made within 60 days of the date of termination under Medicaid or CHIP. 6) Applicable federal or state law or regulation otherwise provides for special enrollment.

  • 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.

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

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Eligibility and Enrollment 2.3.1 The State of Georgia has the sole authority for determining eligibility for the Medicaid program and whether Medicaid beneficiaries are eligible for Enrollment in GF. DCH or its Agent will determine eligibility for PeachCare for Kids™ and will collect applicable premiums. DCH or its agent will continue responsibility for the electronic eligibility verification system (EVS). 2.3.2 DCH or its Agent will review the Medicaid Management Information System (MMIS) file daily and send written notification and information within two (2) Business Days to all Members who are determined eligible for GF. A Member shall have thirty (30) Calendar Days to select a CMO plan and a PCP. Each Family Head of Household shall have thirty (30) Calendar Days to select one (1) CMO plan for the entire Family and PCP for each member. DCH or its Agent will issue a monthly notice of all Enrollments to the CMO plan. 2.3.3 If the Member does not choose a CMO plan within thirty (30) Calendar Days of being deemed eligible for GF, DCH or its Agent will Auto-Assign the individual to a CMO plan using the following algorithm: · If an immediate family member(s) of the Member is already enrolled in one CMO plan, the Member will be Auto-Assigned to that plan; · If there are no immediate family members already enrolled and the Member has a Historical Provider Relationship with a Provider, the Member will be Auto-Assigned to the CMO plan where the Provider is contracted; · If the Member does not have a Historical Provider Relationship with a Provider in any CMO plan, or the Provider contracts with all plans, the Member will be Auto-Assigned based on an algorithm determined by DCH that may include quality, cost, or other measures. 2.3.4 Enrollment, whether chosen or Auto-Assigned, will be effective at 12:01 a.m. on the first (1st) Calendar Day of the month following the Member selection or Auto-Assignment, for those Members assigned on or between the first (1st) and twenty-fourth (24th) Calendar Day of the month. For those Members assigned on or between the twenty-fifth (25th) and thirty-first (31st) Calendar Day of the month, Enrollment will be effective at 12:01 a.m. on the first (1st) Calendar Day of the second (2nd) month after assignment. 2.3.5 In the future, at a date to be determined by DCH, DCH or its Agent may include quality measures in the Auto-Assignment algorithm. Members will be Auto-Assigned to those plans that have higher scores based on quality, cost, or other measures to be defined by DCH. This factor will be applied after determining that there are no Historical Provider Relationships. 2.3.6 In any Service Region, DCH may, at its discretion, set a threshold percentage for the enrollment of members in a single plan and change this threshold percentage at its discretion. Members will not be Auto-Assigned to a CMO plan that exceeds this threshold unless a family member is enrolled in the CMO plan or a Historical Provider Relationship exists with a Provider that does not participate in any other CMO plan in the Service Region. When DCH changes the threshold percentage in any Service Region, DCH will provide the CMOs in the Service Region with a minimum of fourteen (14) days advance notice in writing. 2.3.7 DCH or its Agent will have five (5) Business Days to notify Members and the CMO plan of the Auto-Assignment. Notice to the Member will be made in writing and sent via surface mail. Notice to the CMO plan will be made via file transfer. 2.3.8 DCH or its Agent will be responsible for the consecutive Enrollment period and re-Enrollment functions. 2.3.9 Conditioned on continued eligibility, all Members will be enrolled in a CMO plan for a period of twelve (12) consecutive months. This consecutive Enrollment period will commence on the first (1st) day of Enrollment or upon the date the notice is sent, whichever is later. If a Member disenrolls from one CMO plan and enrolls in a different CMO plan, consecutive Enrollment period will begin on the effective date of Enrollment in the second (2nd) CMO plan. 2.3.10 DCH or its Agent will automatically enroll a Member into the CMO plan in which he or she was most recently enrolled if the Member has a temporary loss of eligibility, defined as less than sixty (60) Calendar Days. In this circumstance, the consecutive Enrollment period will continue as though there has been no break in eligibility, keeping the original twelve (12) month period. 2.3.11 DCH or its Agent will notify Members at least once every twelve (12) months, and at least sixty (60) Calendar Days prior to the date upon which the consecutive Enrollment period ends (the annual Enrollment opportunity), that they have the opportunity to switch CMO plans. Members who do not make a choice will be deemed to have chosen to remain with their current CMO plan. 2.3.12 In the event a temporary loss of eligibility has caused the Member to miss the annual Enrollment opportunity, DCH or its Agent will enroll the Member in the CMO plan in which he or she was enrolled prior to the loss of eligibility. The member will receive a new 60-calendar day notification period beginning the first day of the next month. 2.3.13 In accordance with current operations, the State will issue a Medicaid number to a newborn upon notification from the hospital, or other authorized Medicaid provider. 2.3.14 Upon notification from a CMO plan that a Member is an expectant mother, DCH or its Agent shall mail a newborn enrollment packet to the expectant mother. This packet shall include information that the newborn will be Auto-Assigned to the mother’s CMO plan and that she may, if she wants, select a PCP for her newborn prior to the birth by contacting her CMO plan. The mother shall have ninety (90) Calendar Days from the day a Medicaid number was assigned to her newborn to choose a different CMO plan. 2.3.15 DCH may, at its sole discretion, elect to modify this threshold and/or use quality based auto-assignments for reasons it deems necessary and proper.