ENROLLEE RIGHTS AND NOTIFICATION Clause Samples

ENROLLEE RIGHTS AND NOTIFICATION. 13.1 Information Requirements a) The Contractor shall provide new Enrollees with the information identified in PHL § 4408, SSL § 364-j, SSL § 369-ee and 42 CFR § 438.10 (f) and (g). b) The Contractor shall provide such information to the Enrollee within fourteen (14) days of the Effective Date of Enrollment. The Contractor may provide such information to the Enrollee through the Member Handbook referenced in Section 13.4 of this Agreement. c) The Contractor must provide Enrollees with an annual notice that this information is available to them upon request. d) The Contractor must inform Enrollees that oral interpretation service is available for any language and that information is available in alternative formats and how to access these formats. 13.2 Provider Directories/Office Hours for Participating Providers a) The Contractor shall maintain and update, on a quarterly basis, a listing by specialty of the names, addresses and telephone numbers of all Participating Providers, including facilities. Such a list/directory shall include names, office addresses, telephone numbers, board certification for physicians, information on language capabilities, and wheelchair accessibility of Participating Providers. The list should also identify providers that are not accepting new patients. b) New Enrollees must receive the most current complete listing in hardcopy, along with any updates to such listing. c) Enrollees must be notified of updates in writing at least annually in one of the following methods: (1) provide updates in hardcopy; (2) provide a new complete listing/directory in hardcopy; or (3) provide written notification that a new complete listing/directory is available and will be provided upon request either in hardcopy, or electronically if the Contractor has the capability of providing such data in an electronic format and the data is requested in that format by an Enrollee. d) In addition, the Contractor must make available to the LDSS the office hours for Participating Providers. This requirement may be satisfied by providing a copy of the list or Provider Directory described in this Section with the addition of office hours or by providing a separate listing of office hours for Participating Providers. 13.3 Member ID Cards a) The Contractor must issue an identification card to the Enrollee containing the following information: i) the name of the Enrollee's clinic (if applicable); ii) the name of the Enrollee's PCP and the PCP's telephone number (if...