Involuntary Disenrollment Requests Sample Clauses

Involuntary Disenrollment Requests. The Reform Health Plan shall submit involuntary disenrollment requests for the following reasons to the Agency’s choice counselor/enrollment broker as specified in the Health Plan Report Guide. In no event shall the Health Plan submit a disenrollment request at such a date as would cause the disenrollment to be effective later than forty-five (45) calendar days after the Health Plan’s receipt of the reason for involuntary disenrollment. The Health Plan shall ensure that involuntary disenrollment documents are maintained in an identifiable enrollee record.
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Involuntary Disenrollment Requests. The Department may approve an involuntary disenrollment with an effective date that will be the next available benefit month based on enrollment system logic, except for specific cases or persons where there is a situation where enrollment would be harmful to the interests of the member or in which the HMO cannot provide the member with appropriate medically necessary contract services for reasons beyond its control. For any request for involuntary disenrollment, the HMO must submit a disenrollment request to the Department and include evidence attesting to cause. The HMO must direct all members with involuntary disenrollment requests to the Department’s Enrollment Specialist for assistance and/or for choice counseling. This might include, but is not limited to:
Involuntary Disenrollment Requests. The Department may approve an involuntary disenrollment with an effective date that will be the next available benefit month based on enrollment system logic, except for specific cases or persons where there is a situation where enrollment would be harmful to the interests of the member or in which the PIHP cannot provide the member with appropriate medically necessary contract services for reasons beyond its control. The PIHP must direct all members with involuntary disenrollment requests to the Department’s Enrollment Specialist for assistance and/or for choice counseling. For any request for involuntary disenrollment, the PIHP must submit a disenrollment request to the Department and include evidence attesting to cause which might include, but is not limited to:
Involuntary Disenrollment Requests. The Department may approve an involuntary disenrollment with an effective date that will be the next available benefit month based on enrollment system logic, except for specific cases or persons where there is a situation where enrollment would be harmful to the interests of the member or in which the PIHP cannot provide the member with appropriate medically necessary contract services for reasons beyond its control. For any request for involuntary disenrollment, the PIHP must submit a disenrollment request to the Department and include evidence attesting to cause which might include, but is not limited to:
Involuntary Disenrollment Requests. (See Attachment II, Exhibit 3)
Involuntary Disenrollment Requests a. With proper written documentation, the following are acceptable reasons for which the Managed Care Plan may submit involuntary disenrollment requests to the Agency or its agent:

Related to Involuntary Disenrollment Requests

  • Enrollment Period 1. An “annual” enrollment period shall be held at a time mutually agreed upon by the District and the Association. During the enrollment period, any employee previously eligible for benefits who had not enrolled in one of the Board provided health- care options will be permitted to enroll in such a plan, subject to carrier provisions. During the enrollment period, dependents previously eligible for benefits who had not enrolled in one of the Board provided health- care options will be permitted to enroll in such a plan.

  • Open Enrollment Period Open Enrollment is a period of time each year when you and your eligible dependents, if family coverage is offered, may enroll for healthcare coverage or make changes to your existing healthcare coverage. The effective date will be on the first day of your employer’s plan year. Special Enrollment Period A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health coverage. You and your eligible dependents may enroll for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days of the following events: • you get married, the coverage effective is the first day of the month following your marriage. • you have a child born to the family, the coverage effective date is the date of birth. • you have a child placed for adoption with your family, the coverage effective date is the date of placement. Special note about enrolling your newborn child: You must notify your employer of the birth of a newborn child and pay the required premium within thirty -one (31) days of the date of birth. Otherwise, the newborn will not be covered beyond the thirty -one (31) day period. This plan does not cover services for a newborn child who remains hospitalized after thirty-one (31) days and has not been enrolled in this plan. If you are enrolled in an Individual Plan when your child is born, the coverage for thirty- one (31) days described above means your plan becomes a Family Plan for as long as your child is covered. Applicable Family Plan deductibles and maximum out-of-pocket expenses may apply. In addition, if you lose coverage from another plan, you may enroll or add your eligible dependents for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days following the date you lost coverage. Coverage will begin on the first day of the month following the date your coverage under the other plan ended. In order to be eligible, the loss of coverage must be the result of: • legal separation or divorce; • death of the covered policy holder; • termination of employment or reduction in the number of hours of employment; • the covered policy holder becomes entitled to Medicare; • loss of dependent child status under the plan; • employer contributions to such coverage are being terminated; • COBRA benefits are exhausted; or • your employer is undergoing Chapter 11 proceedings. You are also eligible for a Special Enrollment Period if you and/or your eligible dependent lose eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), or if you and/or your eligible dependent become eligible for premium assistance for Medicaid or a (CHIP). In order to enroll, you must provide required information within sixty (60) days following the change in eligibility. Coverage will begin on the first day of the month following our receipt of your application. In addition, you may be eligible for a Special Enrollment Period if you provide required information within thirty (30) days of one of the following events: • you or your dependent lose minimum essential coverage (unless that loss of coverage is due to non-payment of premium or your voluntary termination of coverage); • you adequately demonstrate to us that another health plan substantially violated a material provision of its contract with you; • you make a permanent move to Rhode Island: or • your enrollment or non-enrollment in a qualified health plan is unintentional, inadvertent, or erroneous and is the result of error, misrepresentation, or inaction by us or an agent of HSRI or the U.S. Department of Health and Human Services (HHS).

  • Other Payroll Deductions 2.3.1 Upon appropriate written authorization from the employee, the Board shall deduct from the salary of any employee and make appropriate remittance for annuities, tax-deferred annuities, credit union or any other plans or programs jointly agreed upon.

  • Involuntary Withdrawal Involuntary withdrawal of a Partner shall include, but not be limited to, the following:

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. Eligibility of an Employee In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Enrollment of a Member Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.

  • Involuntary Demotion An employee assigned to a lower rated position shall continue to be paid at the employee's current rate of pay until the rate of pay in the new position equals or exceeds it.

  • Voluntary Withdrawal If any Partner should withdraw from the Partnership, they must give at least days’ written notice to the Partnership. Such withdrawal shall have no effect on the day-to-day operations of the Partnership.

  • Contribution Formula Health Coverage a. Faculty Member Coverage. For faculty member health coverage for the 2018 2022 and 2019 2023 plan years, the Employer contributes an amount equal to ninety-five percent (95%) of the employee- only premium of the Minnesota Advantage Health Plan (Advantage).

  • Voluntary Reduction in Hours Appointing Authorities may allow employee(s) to take unpaid leaves of absence to reduce layoffs otherwise necessary. If it is necessary to limit the number of employees in a work unit on unpaid leave at the same time, the Appointing Authority shall determine whether conflicts shall be resolved among classes or within a particular class based upon staffing needs. In either event, leave shall be granted on the basis of State Seniority within the employee's work unit. Such employees taking leaves of absence under this Section shall continue to accrue vacation and sick leave and be eligible for paid holidays and insurance benefits as if the employees had been actually employed during the time of leave. If a leave of absence is for one (1) full pay period or longer, any holiday pay shall be included in the first payroll period warrant after return from the leave of absence. Upon return from leave, the employee shall return to his/her former position.

  • Voluntary Deductions A. The Employer agrees to deduct from the wages of any employee who is a member of the Union a DRIVE and/or a Teamsters Legal Defense Fund deduction as provided for in a written authorization. Such authorization must be executed by the employee and may be revoked by the employee at any time by giving written notice to both the Employer and the Union. The beginning and/or termination of this deduction will coincide with the payroll cycle. The Employer agrees to remit any deductions made pursuant to this provision to the Union together with a report showing:

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