NEW ENROLLMENT Sample Clauses

The "New Enrollment" clause defines the terms and conditions under which new participants or members may join a program, service, or agreement. It typically outlines eligibility requirements, the process for submitting enrollment applications, and any associated fees or documentation needed for acceptance. By clearly specifying how and when new enrollments are permitted, this clause ensures transparency and consistency, helping to manage expectations and prevent disputes regarding the admission of new parties.
NEW ENROLLMENT. PERSON (S) NAMED ON THE ACCOUNT (print exactly as it appears on your check) ACCOUNT TYPE SAVINGS OR CHECKING (Circle only One) *ABA NUMBER ACCOUNT NUMBER *Please confirm with your financial institutions that the ABA No. and account type is correct for Direct Deposit. Please attach a voided personal check or a copy of a personal check.
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NEW ENROLLMENT. Check here if you have never participated in UK’s voluntary retirement plan before. If you do not have an existing account with the company(ies) selected, an application form for each company selected must accompany this authorization.
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NEW ENROLLMENT. Select New Enrollment to enroll as an employer in the eGarnishment Program and allow FTB to serve Earnings Withholding Orders for Taxes (EWOTs), Earnings Withholding Orders (EWOs), delays, modifications, terminations, and any other notice or document to be provided (collectively, “eGarnishments”) to the employer or the payroll service provider (PSP) by electronic transmission. This completed and signed enrollment form serves as the official data processing document with us. Select Terminate Enrollment to end the employer’s participation in the eGarnishment Program and receive paper garnishments. Selecting this option will end electronic delivery of garnishments to the current PSP. To change your participation, e.g., have garnishments electronically delivered to the employer directly or to change PSPs, re-enroll by selecting New Enrollment. Refer to FTB 1052, Electronic Wage Garnishment Program Participation Guide, for additional information. Refer to How to Get Forms. In this document, we refer the federal employer identification number as FEIN and the state employer identification number as SEIN. Check the appropriate box and complete the listed sections. ◻ New Enrollment (Complete Part 1, and Part 2 if applicable.) ◻ Terminate Enrollment (Complete Part 1, and Part 2 if applicable.)
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NEW ENROLLMENT. Select New Enrollment to enroll as an employer in the eGarnishment Program and allow FTB to serve Earnings Withholding Orders for Taxes (EWOTs), Earnings Withholding Orders (EWOs), delays, modifications, terminations, and any other notice or document to be provided (collectively, “eGarnishments”) to the employer or the payroll service provider (PSP) by electronic transmission. This completed and signed enrollment form serves as the official data processing document with us. Select Terminate Enrollment to end the employer’s participation in the eGarnishment Program and receive paper garnishments. Selecting this option will end electronic delivery of garnishments to the current PSP. To change your participation, e.g., have garnishments electronically delivered to the employer directly or to change PSPs, re-enroll by selecting New Enrollment. Refer to FTB 1052, Electronic Wage Garnishment Program Participation Guide, for additional information. Refer to How to Get Forms. In this document. we refer the federal employer identification number as FEIN and the state employer identification number as SEIN. Check the appropriate box and complete the listed sections. ◻ New Enrollment (Complete Part 1, and Part 2 if applicable.) ◻ Terminate Enrollment (Complete Part 1, and Part 2 if applicable.) Legal name of employer ▇▇▇▇ Trade name of business (doing business as, if different from legal name) SEIN Street address (number and street) or PO box Apt. no./ste. no. City State ZIP Code Foreign address Primary contact’s first and last name Phone Email Secondary contact’s first and last name Phone Email The employer can authorize FTB to electronically send eGarnishments to their PSP in lieu of their employer. If during the employer’s participation in the eGarnishment Program with a PSP, the PSP notifies FTB that they will no longer process eGarnishments for the employer, the employer’s participation will be deemed terminated. The employer will need to submit a new enrollment form to receive eGarnishments or to have a new PSP receive eGarnishments on their behalf. Payroll service provider’s name Street address (number and street) or PO box Apt. no./ste. no. City State ZIP Code Primary contact’s first and last name Phone Email Secondary contact’s first and last name Phone Email Technical contact’s first and last name Phone Email By signing this Electronic Wage Garnishment Agreement, I certify all of the following statements: • I am an individual who is identified as the primar...
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NEW ENROLLMENT. Check here if you have never participated in UK’s 457(b) voluntary retirement plan before. If
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NEW ENROLLMENT. Check here if you have never participated in the University’s 457(b) voluntary account with the company(ies) selected. An application form for each company selected must accompany this authorization.
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NEW ENROLLMENT 
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Related to NEW ENROLLMENT

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

  • 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.

  • 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.‌

  • 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.