Enrollment; Disenrollment Clause Samples
The "Enrollment; Disenrollment" clause defines the procedures and requirements for individuals or entities to join or leave a program, plan, or service. It typically outlines the steps necessary to enroll, such as submitting applications or meeting eligibility criteria, as well as the process for disenrollment, which may include providing notice or fulfilling certain conditions. This clause ensures that both parties understand how participation begins and ends, thereby providing clarity and structure to the management of membership or coverage.
Enrollment; Disenrollment. Procedures for enrollment of an individual in Qualified Vendor services and termination of enrollment with the Qualified Vendor shall be in accordance with the agreement and all applicable Division and/or AHCCCS rules and policies.
Enrollment; Disenrollment a. The DEPARTMENT through a central enrollment broker contract will handle enrollment, disenrollment and initial selection of PCP.
b. Coverage for new Members will be effective the first of the month and coverage for disenrollments will terminate at the end of the month.
c. Members remain continuously enrolled throughout the term of this contract, except in situations where clients
1. Change health plans,
2. Lose their Medicaid eligibility, 3. Receive Medicare, or
Enrollment; Disenrollment. Premium payments are based on the number of Members enrolled. The Group must notify Coventry of the enrollment or disenrollment of a Member, by submitting an enrollment/change form to Us within thirty-one (31) days of the enrollment or disenrollment. If the Group fails to timely report such changes, an appropriate retroactive adjustment of any excess premiums paid on behalf of a Member shall be made by Coventry to the Group; however, the maximum retroactive adjustment is up to thirty-one (31) days prior to the date Coventry was notified of the change. If Coventry pays for any benefits, claims, administration costs, and other expenses incurred by the Group and/or Member after the termination date of the Group and/or Member, then Coventry has the right to recoup from the Provider, or collect from the Group and/or Member, all monies paid after the termination date for such expenses.
Enrollment; Disenrollment. 1. To accept enrollments of recipients authorized to enroll into an MCO by MDH and process enrollments in accordance with 42 CFR 438.54 and COMAR 10.67.02.02 (Appendix S).
2. To accept enrollment of recipients who are pregnant but would otherwise not be eligible for services due to their immigration status, as required by the Healthy Babies Equity Act (Md. Code ▇▇▇. Health- General Art. 15-103(a)(3)(xviii)).
3. To request disenrollment only for the reasons set forth in COMAR 10.67.02.06D (Appendix S) and 42 CFR 438.56.
4. To comply with MDH’s disenrollment policies and procedures, which are set forth in COMAR 10.67.02.05, 10.67.02.06, and 10.09.69.04 (Appendix S).
5. To submit to MDH, within thirty (30) days of the date the MCO receives the monthly enrollment listings from MDH, a list of Enrollees who are known to the MCO to have:
A. Disenrolled from the HealthChoice Program;
B. Relocated to a geographic area not serviced by the MCO;
C. Become ineligible to receive HealthChoice Program services from the MCO; or
D. Died.
6. To submit any additional information MDH requests about the Enrollees referenced in II.B.4 of this Agreement.
7. To process Enrollee updates provided by MDH in a timely manner, including but not limited to Enrollee demographic updates and Enrollee primary care provider selections.
8. To comply with MDH’s Covid-19 public health emergency unwinding policies and procedures, including:
A. Conducting outreach to disenrolled individuals during the 120-day reconsideration period; and,
B. Assisting Enrollees with renewal applications per the Section 1902(e)(14)(A) waiver held by MDH.
Enrollment; Disenrollment