Annual Health-Plan Selection Sample Clauses

Annual Health-Plan Selection. ‌ The MCO shall accept enrollment of any eligible Beneficiaries during any annual health-plan selection period required by the STATE or CMS.
Sample 1Sample 2Sample 3See All (21)
AutoNDA by SimpleDocs
Annual Health-Plan Selection. The MCO shall accept enrollment of any eligible Beneficiaries during any annual health-plan selection period required by the STATE or CMS. Period of Enrollment. Each MSC+ Enrollee shall be enrolled for twelve (12) months following the effective date of coverage, subject to the exceptions in this section. For MSHO, each Enrollee may choose to disenroll at the end of any month consistent with paragraph (J) below. The MCO agrees to retain Medicare eligible Enrollees for up to three months after losing their Medicaid eligibility in the MCO, including Enrollees who no longer meet the requirements for managed care enrollment as part of the MCO’s Medicare Special Needs Plan enrollment. Voluntary Enrollment for MSHO. Enrollment in the MCO for the MSHO program shall be voluntary. Single MCO Entity Provider. For MSC+, if the MCO is a single entity provider in a Rural Area, the MCO must allow Beneficiaries: 1) to choose from at least two Network Providers; and 2) to obtain services from any other Provider when the circumstances allow pursuant to 42 CFR § 438.52. Enrollee Change of MCO. Enrollees may change to a different MSHO MCO every thirty (30) days, and for MSC+ and MSHO upon request to the MCO during the open enrollment period, or as allowed under Minnesota Rules, part 9500.1453, subparts 5, 7, and 8, and 42 CFR Part 438. Enrollee Change of Primary Care Provider. The Enrollee may change to a different Primary Care Provider within the MCO’s network or Care System every thirty (30) days upon request to the MCO. This section does not apply to Enrollees who are under restriction pursuant to section 9.17. No Random Assignment of Provider. In no circumstance shall the MCO randomly assign an Enrollee to a Primary Care Provider upon reenrollment. Choice of Network Provider. The MCO must allow an Enrollee to choose his or her Network Provider to the extent possible and appropriate.
Sample 1Sample 2Sample 3See All (7)

Related to Annual Health-Plan Selection

  • Shift Selection In multiple shift operations, employees within each classification shall have a right to select their work shift on the basis of their seniority within a bureau or division thereof and competing only with employees covered under this agreement on the following basis:

  • Provider Selection To the extent applicable to Provider in performance of the Agreement, Provider shall comply with 42 CFR 438.214, as may be amended from time to time, which includes, but is not limited to the selection and retention of providers, credentialing and recredentialing requirements and nondiscrimination. If Subcontractor and/or Health Plan delegate credentialing to Provider, Subcontractor and/or Health Plan will provide monitoring and oversight and Provider shall ensure that all licensed medical professionals are credentialed in accordance with Health Plan’s and the State Contract’s credentialing requirements.

  • Health Promotion Incentives The Joint Labor-Management Committee on Health Plans shall develop a program which provides incentives for employees who participate in a health promotion program. The health promotion program shall emphasize the adoption and maintenance of more healthy lifestyle behaviors and shall encourage wiser usage of the health care system.

  • Oregon Public Service Retirement Plan Pension Program Members For purposes of this Section 2, “employee” means an employee who is employed by the State on or after August 29, 2003 and who is not eligible to receive benefits under ORS Chapter 238 for service with the State pursuant to Section 2 of Chapter 733, Oregon Laws 2003.

  • Personnel Selection Leave 35.6.1 Where an employee participates in a personnel selection process for a position in the Public Service, as defined in the Financial Administration Act, the Council shall grant leave of absence with pay for the period during which the employee's presence is required for purposes of the selection process, and for such further period as the Council considers reasonable for the employee to travel to and from the place where his presence is so required.

  • Disenrollment Adverse Benefit Determination taken by the Division, or its Agent, to remove a Member's name from the monthly Member Listing report following the Division's receipt and approval of a request for Disenrollment or a determination that the Member is no longer eligible for Enrollment in the Contractor.

  • Selection Planning Prior to the issuance to consultants of any requests for proposals, the proposed plan for the selection of consultants under the Project shall be furnished to the Association for its review and approval, in accordance with the provisions of paragraph 1 of Appendix 1 to the Consultant Guidelines. Selection of all consultants’ services shall be undertaken in accordance with such selection plan as shall have been approved by the Association, and with the provisions of said paragraph 1.

  • Personnel Selection Leave With Pay Where an employee participates in a personnel selection process, including the appeal process where applicable, for a position in the Public Service or in the Office of the Superintendent of Financial Institutions, as defined in the Public Service Labour Relations Act, the employee is entitled to leave with pay for the period during which the employee's presence is required for purposes of the selection process, and for such further period as the Employer considers reasonable for the employee to travel to and from the place where his presence is so required.

  • Initial Enrollment Upon retirement, each new retiree who is eligible to enroll in plans under the Health Benefits Program shall receive uninterrupted coverage under the plan in which he or she was enrolled as an active employee, provided the employee submits all necessary applications and other required documentation in a timely fashion.

  • Medical Benefits - Prescription Drugs Administered by a Provider (other than a pharmacist) This plan covers prescription drugs as a medical benefit, referred to as “medical prescription drugs”, when the prescription drug requires administration (or the FDA approved recommendation is administration) by a licensed healthcare provider (other than a pharmacist). Please note: Specialty prescription drugs meeting these requirements or recommendations are covered as a pharmacy benefit and not a medical benefit. These medical prescription drugs include, but are not limited to, medications administered by infusion, injection, or inhalation, as well as nasal, topical or transdermal administered medications. For some of these medical prescription drugs, the cost of the prescription drug is included in the allowance for the medical service being provided, and is not separately reimbursed.

Time is Money Join Law Insider Premium to draft better contracts faster.