LDSS Initiated Disenrollment Sample Clauses

LDSS Initiated Disenrollment. Section 9 Guaranteed Eligibility
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LDSS Initiated Disenrollment a) The LDSS is responsible for promptly initiating Disenrollment when: i) an Enrollee is no longer eligible for MMC or FHPlus; or ii) the Guaranteed Eligibility period ends and an Enrollee is no longer eligible for MMC or FHPlus benefits; or iii) an Enrollee is no longer the financial responsibility of the LDSS; or iv) an Enrollee becomes ineligible for Enrollment pursuant to Section 6.1 of this Agreement; or v) an Enrollee has moved outside the service area covered by this Agreement, unless Contractor can demonstrate that: A) the Enrollee has made an informed choice to continue Enrollment with the Contractor and that Enrollee will have sufficient access to the Contractor's provider network; and B) fiscal responsibility for Medicaid or FHPlus coverage remains in the county of origin. SECTION 8 (DISENROLLMENT) October 1, 2005 8-4
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LDSS Initiated Disenrollment a) An LDSS will promptly initiate disenrollment when: i) an Enrollee is no longer eligible for FHPlus; or FHPlus - Section 8 (DISENROLLMENT) October 1, 2001 8-5 ii) the Guaranteed Eligibility Period ends (See Section 9) and an Enrollee is no longer eligible for FHPlus; or iii) an Enrollee is no longer the financial responsibility of the LDSS; or iv) an Enrollee resides outside the Service Area covered by this Agreement unless Contractor can demonstrate that the Enrollee has made an informed choice to continue enrollment with Contractor and that Enrollee will have sufficient access to Contractor's provider network. FHPlus - Section 8 (DISENROLLMENT) October 1, 2001 8-6
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LDSS Initiated Disenrollment a) LDSS will promptly, initiate disenrollment when: i) AN Enrollee is no longer eligible for any Medicaid benefits; or the Guaranteed Eligibility period ends (See Section 9) and an Enrollee is no longer eligible for any Medicaid benefits; or
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LDSS Initiated Disenrollment a) LDSS will promptly initiate disenrollment when: i) an Enrollee is no longer eligible for any Medicaid benefits; or ii) the Guaranteed Eligibility period ends (See Section 9) and an Enrollee is no longer eligible for any Medicaid benefits; or iii) an Enrollee is no longer the financial responsibility of the LDSS; or iv) an Enrollee becomes ineligible for enrollment pursuant to Section 5.3 of this Agreement, as appropriate; or v) an Enrollee resides out side the Service Area covered by this Agreement, unless Contractor can demonstrate that the Enrollee has made an informed choice to continue enrollment with Contractor and that Enrollee will have sufficient access to Contractor's provider network.
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LDSS Initiated Disenrollment a) The LDSS is responsible for promptly initiating Disenrollment from the Contractor's Medicaid Advantage Product when: i) an Enrollee fails to enroll or stay enrolled in the Contractor's Medicare Advantage Product as specified in Sections 6.9 and 8.3(b)(iv) of this Agreement; or ii) an Enrollee is no longer eligible for Medicaid or Medicaid Advantage; benefits; or iii) the Guaranteed Eligibility period ends (See Section 9) and an Enrollee, is no longer eligible for any Medicaid benefits; or iv) an Enrollee is no longer the financial responsibility of the LDSS; or v) an Enrollee becomes ineligible for Enrollment pursuant to Section 5.2 of this Agreement, as appropriate.
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Related to LDSS Initiated Disenrollment

  • 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.‌

  • 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.

  • Notice of Enrollment Notice shall include a list of new employees represented by the Union scheduled to attend the NEO. If practical, the City agrees to provide additional identifying information including, but not limited to, classification and department. Six months from enactment, in the event the City is unable to provide classification and department information in the Notice of Enrollment, the Union can reopen this Agreement for the sole purpose of meeting and conferring over the identifying information provided in this Section II.C.3

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department shall advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor shall be bound by the changes in enrollment procedures.