Member Disenrollment from MCE Sample Clauses

Member Disenrollment from MCE. In accordance with 42 CFR 438.56(b)(2), the Contractor may neither terminate enrollment nor encourage a member to disenroll because of a member’s health care needs, adverse change in a member’s health care status, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs (except when his or her continued enrollment seriously impairs the Contractor’s ability to furnish services to the member or other members). A member’s health care utilization patterns may not serve as the basis for disenrollment from the Contractor. In accordance with 42 CFR 438.3(q)(5); 42 CFR 438.56(c)(1); and 42 CFR 438.56(c)(2)(i)-(iii), members have the right to disenroll from the Contractor: ▪ For cause, at any time. ▪ Without cause within ninety (90) days after initial enrollment or during the ninety (90) days following notification of enrollment, whichever is later. ▪ Without cause at least once every twelve (12) months. ▪ Without cause when a Contractor repeatedly fails to meet substantive requirements in sections 1903(m) or 1932 of the Social Security Act or 42 CFR 438. Per 42 CFR 438.796(b)-(d) and section 1932(e)(2)(B)(ii) of the Social Security Act. ▪ Without cause upon reenrollment if a temporary loss of enrollment has caused the enrollee to miss the annual disenrollment period. In accordance with 42 CFR 438.56(d)(2)(i)-(v), members may request disenrollment if the: ▪ Member moves out of the service area. ▪ Contractor does not cover the service the enrollee seeks, because of moral or religious objections. ▪ Member needs related services to be performed at the same time and not all related services are available within the provider network. The member’s provider must determine that receiving the services separate would subject the member to unnecessary risk. ▪ Contractor’s provider status changes from in-network to out-of-network causes the member to have to change their residential, institutional, or employment supports provider, and, as a result, the member would experience a disruption in their residence or employment. ▪ Member experiences poor quality of care, lack of access to services covered under the Contract, or lack of access to providers experienced in dealing with the member’s care needs. See additional standards and procedures allowing for change of Contractor in the Member Handbook section. The Contractor shall notify FSSA in the manner outlined in the Hoosier Healthwise MCE Policies and Procedures Manual, within...
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Member Disenrollment from MCE. In accordance with 42 CFR 438.6(k), which addresses enrollment and disenrollment, the Contractor may neither terminate enrollment nor encourage a member to disenroll because of a member’s health care needs or a change in a member’s health care status. A member’s health care utilization patterns may not serve as the basis for disenrollment from the Contractor. The Contractor shall notify OMPP in the manner outlined in the Hoosier Healthwise MCE Policies and Procedures Manual, within thirty (30) calendar days of the date it becomes aware of the death of one of its members, giving the member's full name, address, Social Security Number, member identification number and date of death. The Contractor will have no authority to pursue recovery against the estate of a deceased Medicaid member. Additional information about the member disenrollment process is provided in Exhibit 7 and the Hoosier Healthwise MCE Policies and Procedures Manual.
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Related to Member Disenrollment from MCE

  • 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).

  • REGISTERED RETIREMENT SAVINGS PLAN 1. In this Article:

  • Dependent Care Salary Reduction Plan The Employer agrees to maintain the current dependent care salary reduction plan that allows eligible employees, covered by this Agreement, the option to participate in a dependent care reimbursement program for work-related dependent care expenses on a pretax basis as permitted by federal tax law or regulation.

  • Re-enrollment Any eligible employees who wish to join the Sick Leave Bank after their first year of eligibility will contribute two (2) days upon joining. Such membership may only be made during the month of October using the appropriate forms. The two (2) required days of leave shall be donated from their account upon enrollment in the Classified Employee Council (CEC).

  • When Must Distributions from a Traditional IRA Begin You must begin receiving the assets in your account no later than April 1 following the calendar year in which you reach RMD age.

  • Other Payroll Deductions In addition to the above, the City will deduct from an employee's payroll check, upon authorization by the employee, amounts payable to causes or organizations selected by the Union. At any one time, no more than ten (10) such causes or organizations may be identified by the Union as authorized to benefit from such payroll deductions unless otherwise authorized by the City in its sole discretion. The Union will notify the City of the causes and organizations to be so authorized. Payroll deductions shall be governed by the ability of the City Auditor's payroll system to handle same.

  • Initial Enrollment Upon retirement, each new retiree who is eligible to enroll in plans under the Health Benefits Program shall receive uninterrupted coverage under the plan in which he or she was enrolled as an active employee, provided the employee submits all necessary applications and other required documentation in a timely fashion.

  • Oregon Public Service Retirement Plan Pension Program Members For purposes of this Section 2, “employee” means an employee who is employed by the State on or after August 29, 2003 and who is not eligible to receive benefits under ORS Chapter 238 for service with the State pursuant to Section 2 of Chapter 733, Oregon Laws 2003.

  • PAYROLL DEDUCTION OF UNION DUES A. Provision shall be made by the District for payroll deductions of employee organization dues and assessments of all members upon written authorization by the employee Union member on an official form. Employees shall authorize dues deduction in accordance with Chapter 41.56.110 RCW when they become Union members. An employee may cancel their payroll deduction of dues and assessments by written notice to the Union and to the District, with the District stopping dues deductions following written confirmation from the Union that the employee’s dues/fees authorization has been terminated in compliance with the terms of the written authorization executed by the employee. The District will make every effort to end the automatic dues deduction effective on the first pay period but no later than the second pay period after receipt of the written cancellation notice from the employee and confirmation from the Union that the cancellation notice is compliant with the terms of the written authorization.

  • How Are Contributions to a Xxxxxxxxx Education Savings Account Reported for Federal Tax Purposes? Contributions to a Xxxxxxxxx Education Savings Account are reported on IRS Form 5498-ESA.

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