Cause for Disenrollment Sample Clauses

Cause for Disenrollment a. A mandatory enrollee may request disenrollment from the Health Plan for cause at any time. Such request shall be submitted to the Agency or its agent. The following reasons constitute cause for disenrollment from the Health Plan:

Cause for Disenrollment a. A Mandatory Enrollee may request Disenrollment from the PSN for Cause at any time. Such request shall be submitted to the Agency or its Agent. The following reasons constitute Cause for Disenrollment from the PSN:

Cause for Disenrollment. (16) Procedures for filing a request for disenrollment for cause. As noted in subparagraph (15), the state-approved for-cause reasons listed in Attachment II, Section III, Eligibility and Enrollment, Item C., Disenrollment, sub-item 3.,a. shall be listed verbatim in the disenrollment section of the enrollee handbook. In addition, the Health Plan shall include the following language verbatim in the disenrollment section of the enrollee handbook: Some Medicaid recipients can change health plans whenever they choose, for any reason. For example, people who are eligible for both Medicaid and Medicare benefits and children who receive SSI benefits can change plans at any time for any reason. To find out if you can change plans, call the [INSERT EITHER “CHOICE COUNSELOR” OR “ENROLLMENT BROKER” AND APPROPRIATE TELEPHONE NUMBER].

Cause for Disenrollment. The following are cause for disenrollment:

Cause for Disenrollment. (4) Description of services provided, including limitations and general restrictions on provider access, exclusions and out-of-network use, and any restrictions on enrollee freedom of choice among participating providers;

Cause for Disenrollment. The following are cause for disenrollment: The enrollee moves out of the MCO's, PIHP's, PAHP’s or PCCM's service area. The plan does not, because of moral or religious objections, cover the service the enrollee seeks. The enrollee needs related services (for example a cesarean section and a tubal ligation), where the related services are not available within the network, and the enrollee's primary care provider or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk. Other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers with experience in the enrollee's health care needs.