Enrollees without SSI Clause Samples

Enrollees without SSI. An Enrollee without SSI shall be offered an opportunity to: (1) choose a new PCP who is affiliated with the Contractor’s Network or (2) stay with their current PCP as long as such PCP is affiliated with the Contractor’s Network. Each Enrollee shall be allowed to choose his or her Primary Care Provider from among all available Contractor Network Primary Care Providers and specialists as is reasonable and appropriate for Enrollee. The Contractor shall have procedures for serving Enrollees from the date of notification of Enrollment, whether or not the Enrollee has selected a PCP. The Contractor shall send Enrollees a written explanation of the PCP selection process within ten (10) Business Days of receiving Enrollment notification from the Department, either as a part of the Enrollee Handbook or by separate mailing. Enrollees will be asked to select a PCP by contacting the Contractor’s Enrollee Services department with their selection. The written communication shall include the timeframe for selection of a PCP, an explanation of the process for assignment of a PCP if the Enrollee does not select a PCP and information on where to call for assistance with the selection process. An Enrollee shall be allowed to select, from all available, but not less than two (2) PCP in the Contractor’s Network. The Contractor shall assign the Enrollee to a PCP: A. Who has historically provided services to the Enrollee, meets the PCP criteria and participates in the Contractor’s Network; B. If there is no such PCP who has historically provided services, the Contractor shall assign the Enrollee to a PCP, who participates in the Contractor’s Network and is within thirty (30) Miles or thirty (30) minutes from the Enrollee’s residence in accordance with the accessibility standards set forth in Section 28.4 “Provider Network Access and Adequacy.” The assignment shall be based on the following: 1. The need of children and adolescents to be followed by pediatric or adolescent specialists; 2. Any special medical needs, including pregnancy; 3. Any language needs made known to the Contractor; and 4. Area of residence and access to transportation.