Eligibility and Enrollment Clause Samples
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:
2.3.3.1 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;
2.3.3.2 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;
2.3.3.3 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 to the CMO plan that has the lowest capitated rates in the Service Region.
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 on quality measures to be defined by DCH. This f...
Eligibility and Enrollment. To enroll and continue enrollment, a Subscriber must be an eligible Employee and meet all of the eligibility requirements for coverage established by the Employer. An Employee is eligible for cov- erage as a Subscriber the day following the date he or she completes the waiting period established by the Employer. The Employee’s spouse or Domes- tic Partner and all Dependent children are eligible for coverage at the same time. An Employee or the Employee’s Dependents may enroll when initially eligible or during the Em- ployer’s annual Open Enrollment Period. Under certain circumstances, an Employee and Depen- dents may qualify for a Special Enrollment Period. Other than the initial opportunity to enroll, a date 12 months from the date a written request for en- rollment is made, the Employer’s annual Open En- rollment period, or a Special Enrollment Period, an Employee or Dependent may not enroll in the health program offered by the Employer. Please see the definition of Late Enrollee and Special En- rollment Period in the Definitions section for de- tails on these rights. For additional information on enrollment periods, please contact the Employer or Blue Shield. Dependent children of the Subscriber, spouse, or his or her Domestic Partner, including children adopted or placed for adoption, will be eligible im- mediately after birth, adoption or the placement of adoption for a period of 31 days. In order to have coverage continue beyond the first 31 days, an ap- plication must be received by Blue Shield within 31 days from the date of birth, adoption or place- ment for adoption. If both partners in a marriage or Domestic Partnership are eligible Employees and Subscribers, children may be eligible and may be enrolled as a Dependent of either parent, but not both. Please contact Blue Shield to determine what evidence needs to be provided to enroll a child. Enrolled disabled Dependent children who would normally lose their eligibility under this Health Plan solely because of age, may be eligible for cov- erage if they continue to meet the definition of De- pendent. See the Definitions section. The Employer must meet specified Employer ▇▇▇- gibility, participation and contribution require- ments to be eligible for this group Health Plan. If the Employer fails to meet these requirements, this coverage will terminate. See the Termination of Benefits section of this EOC for further informa- tion. Employees will receive notice of this termi- nation and, at that time...
Eligibility and Enrollment. Not all new or existing customers are eligible to use the Service. There are qualification and enrollment requirements for participation in the Service, and we reserve the right to change the qualification and enrollment requirements at any time without prior notice. We will also require you to upload a picture of your driver’s license or other identifying documents prior to using the Service. Eligibility requirements can be found within the Mobile App after you have signed into your online account.
Eligibility and Enrollment. There are qualification and enrollment requirements for participation in the Mobile Deposit Service, and we reserve the right to change the qualification and enrollment requirements at any time without prior notice. We may also require you to upload a picture of your driver’s license or other identifying documents prior to using the Mobile Deposit Service.
Eligibility and Enrollment. No change in the Group’s eligibility or participation requirements is effective for purposes of this Agreement unless the Health Plan consents in writing. The Group must:
Eligibility and Enrollment. All Eligible Employees will have the opportunity to apply for coverage under this Contract. All applications submitted to Blue Cross of Idaho (BCI) by the Group now or in the future, will be for Eligible Employees or Eligible Dependents only.
Eligibility and Enrollment. To participate, cardmembers must be individuals who reside in Canada. Only the basic cardmember on the card account is eligible for the rebate. Eligible cardmembers are enrolled automatically upon issuance of the card. We may disqualify any person from participating, or terminate any person’s participation, in the rebate program at our sole option and discretion at any time with or without cause and without giving you notice, including, without limitation, when you are in default under the cardmember agreement.
Eligibility and Enrollment. As a full-time permanent unionized hourly Niagara Falls employee, you become eligible to join the plan on the first of the month following or coincident with completion of one year of service with Post Foods Canada. If you are a temporary employee, you become eligible when you have completed two years of service, provided that you have earned 35% of the Year’s Maximum Pensionable Earnings* in each of those years or worked 700 hours for Post Foods Canada during each of those years. Contributions and benefits will be prorated on the basis of hours worked. You may join at any time after becoming eligible by signing the enrollment form authorizing Post Foods Canada to deduct the required contributions from your earnings and designating a beneficiary. Enrollment forms are available through the Human Resources Department. *-The Year’s Maximum Pensionable Earnings, or YMPE, is the maximum amount of earnings that can be used to determine an individual’s benefits under the Canada Pension Plan. It is adjusted each year to reflect average Canadian wage levels.
Eligibility and Enrollment. (1) Employees in a Bargaining Unit who are scheduled to work forty-one (41) hours or more per pay period in a regular position must enroll in either the County’s Healthcare Benefits plans or SEBA’s Healthcare Benefits plans, unless the employee opts out or waives medical/dental insurance pursuant to the requirements of the Medical and Dental Coverage article. For details on the requirements and eligibility for the SEBA Trust, employees should refer to the SEBA Trust plan document. Medical, dental, and vision coverage and premium subsidies eligibility for active employees will be determined by the terms of the MOU.
(2) Newly hired eligible employees into any of the Bargaining Units may choose to participate in either the County’s Healthcare Benefits plans, or SEBA’s Healthcare Benefits plans under the Trust. For avoidance of doubt, all components of an employee’s Healthcare Benefits—medical and prescription drug, dental, and vision coverage—must be under either the County’s Healthcare Benefits plans, or the SEBA Trust’s Healthcare Benefits plans; an employee cannot be simultaneously covered by both vehicles.
(3) If a newly hired eligible employee fails to select a medical plan upon hire and does not opt out or waive coverage, the employee will be automatically enrolled in the lowest-cost self-only medical and dental coverage options under SEBA’s medical and dental plans, assuming such employee is a dues paying SEBA member. If not a dues paying SEBA member, such employee will be automatically enrolled in the lowest-cost self-only medical and dental coverage options under the County’s medical and dental plans. If an automatically enrolled employee is responsible for paying premiums for such coverage, the amount will be deducted after-tax from their County compensation; any outstanding premium balance will be the employee’s responsibility.
(4) Employees may only change from SEBA Trust plan to County plan during open enrollment or certain Internal Revenue Code (IRC) Section 125 qualifying events that are consistent with such a change. Employees must sign and provide to the County a written authorization for deductions via paper and/or electronic signature. Such employees shall not be eligible for any coverage under the Trust Plans thereafter.
(5) Employees who are not members of a Bargaining Unit will be eligible for coverage under the SEBA Trust upon joining a Bargaining Unit. Once eligible, employees will have the option to enroll in either the County’s or SE...
Eligibility and Enrollment. 2.1 Requirements for Coverage A. The Subscriber must be a Qualified Individual;