Initial Contact, General Orientation Clause Samples
Initial Contact, General Orientation. (A) The Contractor’s representative shall ensure that each Enrollee family or guardian receives the Contractor’s Enrollee Handbook within a reasonable time after the Contractor has been notified of the Enrollees’s enrollment in the Contractor’s Dental Plan. The Contractor shall maintain written or electronic records of such initial contact.
(B) The Contractor’s representative shall make a good faith effort to make an initial contact with the Enrollee within ten working days after the Contractor has been notified through the Eligibility Transmission of the Enrollee’s Enrolment in the Contractor’s Dental Plan. The Contractor shall maintain written or electronic records of such initial contact.
(1) If the Contractor cannot contact the Enrollee within 10 working days or at all, the Contractor’s representative shall document its efforts to contact the Enrollee.
(2) The initial contact shall be in person or by telephone and shall inform the Enrollee of the Contractor’s rules and policies. The initial contact may also be in writing but only if reasonable attempts have been made to contact the Enrollee in person and by telephone and those attempts have been unsuccessful.
(C) The Contractor shall ensure that Enrollees are provided interpreters, Telecommunication Device for the Deaf, and other auxiliary aids to ensure that Enrollees understand their rights and responsibilities.
(D) During the initial contact, the Contractor’s representative shall provide, at minimum, the following information to the Enrollee or Potential Enrollee:
(1) Specific written and oral instructions on the use of the Contractor’s Covered Services and procedures;
(2) The availability and accessibility of all Covered Services;
(3) The rights and responsibilities of the Enrollee under the Dental Plan, including the right to file a Grievance or an Appeal and how to file a Grievance or an Appeal;
(4) The right to terminate enrollment with the Dental Plan;
(5) Encouragement to make a dental appointment with a Provider.
(E) The Contractor shall also provide the information described in Section 3.5.1(D) to the Enrollee upon request from the Enrollee.
Initial Contact, General Orientation. (A) The Contractor shall make a good faith effort to ensure that each Enrollee or Enrollee’s family or guardian receives the Contractor’s Member Handbook.
(B) The Contractor’s representative shall make a good faith effort to send new Enrollees a Member Handbook within 10 working days after the Contractor has been notified through the Eligibility Transmission of the Enrollee’s Enrolment in the Contractor’s Dental Plan. The Contractor shall maintain written or electronic records of the mailing of the Member Handbook.
(C) The Contractor shall ensure that Enrollees are provided interpreters, Telecommunication Device for the Deaf, and other auxiliary aids to the extent necessary to ensure that Enrollees understand their rights and responsibilities.
Initial Contact, General Orientation. (A) During the initial contact, the Contractor’s representative shall provide, at minimum, the following information to the Enrollee or Potential Enrollee:
(1) specific written and oral instructions on the use of the Contractor’s Covered Services and procedures;
(2) explain that to the Enrollee that his/her Primary Care services, medication management, and mental health concerns will be provided at the Contractor’s Clinic;
(3) explain the Contractor’s case management and care coordination model;
(4) introduce the Enrollee to his/her assigned case manager;
(5) provide each Enrollee a HOME Member Handbook, Provider Directory, and ▇▇▇▇ ▇▇▇▇▇ phone list;
(6) availability and accessibility of all Covered Services, including the availability of family planning services and that the Enrollee may obtain family planning services from Non-Network Providers;
(7) the rights and responsibilities of the Enrollee under the Contractor’s Health Plan, including the right to file a Grievance or an Appeal and how to file a Grievance or an Appeal; and
(8) the right to terminate enrollment with the Contractor’s Health Plan.
(B) The Contractor shall ensure that Enrollees are provided interpreters, Telecommunication Device for the Deaf (TDD), and other auxiliary aids to ensure that Enrollees understand their rights and responsibilities.
Initial Contact, General Orientation. (A) Within 30 days of Enrollment, the Contractor shall conduct an in-person welcome intake visit with the Enrollee. During the welcome intake visit the Contractor shall:
(1) explain the Contractor’s program to the Enrollee;
(2) explain that to the Enrollee that his/her primary care services, medication management, and mental health concerns will be provided at the Contractor’s Clinic;
(3) explain the Contractor’s case management and care coordination model;
(4) introduce the Enrollee to his/her assigned case manager; and
(5) Provide each Enrollee a HOME Member Handbook, Provider Directory, and ▇▇▇▇ ▇▇▇▇▇ phone list.