Member Enrollment. Indiana Health Coverage Program applicants have an opportunity to select an MCE on their application. MCEs are expected to conduct marketing and outreach efforts to raise awareness of the Hoosier Healthwise program and their product. The Enrollment Broker is available to assist members in choosing an MCE. Applicants who do not select an MCE on their application will be auto-assigned to an MCE according to the State’s auto- assignment methodology. The State reserves the right to amend the auto-assignment logic and may incorporate HEDIS or other quality indicators into the auto-assignment logic at a future date. Default auto-assignment will not be available to any MCE who does not successfully complete readiness review. In accordance with 42 CFR 438.10(e), the State shall provide to potential members general information about the basic features of managed care and information specific to each MCE operating in the potential member’s service area. At minimum, this information will include factors such as Contractor service area, benefits covered, cost- sharing and network provider information. The State shall provide information on program MCEs in a comparative chart-like format. Once available, the State also intends to include Contractor quality and performance indicators on materials distributed to facilitate MCE selection. The State reserves the right to develop a rating system advertising Contractor performance on areas such as consumer satisfaction, network access and quality improvement. To facilitate State development of these materials, the Contractor shall comply with State requests for information needed to develop informational materials for potential members. Per 42 CFR 438.3(d), the Contractor shall accept individuals eligible for enrollment in the order in which they apply without restriction. The Contractor shall not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll. Additionally, the Contractor shall not discriminate against individuals eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity or disability and will not use any policy or practice that has the effect of discriminating in such manner. Contractor shall also adhere to Section 1557 of the Affordable Care Act / 45 CFR 92.1.
Member Enrollment. The Department is solely responsible for the Enrollment of Medicaid Beneficiaries and Managed Care Members into the Healthy Connections Program. The Department will use its best efforts to ensure that the CONTRACTOR receives timely and accurate Enrollment and Disenrollment information. In the event of discrepancies or unresolvable differences between the Department and the CONTRACTOR regarding Enrollment, Disenrollment and/or termination, the Department will be responsible for taking the appropriate action for resolution.
Member Enrollment. The host site understands that the Program will reduce or renegotiate the awarded member slots at any time if the host site is unable to fill the host site’s AmeriCorps slots.
Member Enrollment. Indiana Health Coverage Program applicants have an opportunity to select an MCE on their application. MCEs are expected to conduct marketing and outreach efforts to raise awareness of both the program and their product. The Enrollment Broker is available to assist members in choosing an MCE. Applicants who do not select an MCE on their application will be auto- assigned to an MCE according to the State’s auto-assignment methodology. The State reserves the right to amend the auto-assignment logic and may incorporate HEDIS or other quality indicators into the auto-assignment logic at a future date. Default auto-assignment will not be available to any MCE who does not successfully complete readiness review In accordance with 42 CFR 438.10(e), the State shall provide to potential members general information about the basic features of managed care and information specific to each MCE operating in the potential member’s service area. At minimum, this information will include factors such as Contractor service area, benefits covered, cost- sharing and network provider information. The State shall provide information on program MCEs in a comparative chart-like format. Once available, the State also intends to include Contractor quality and performance indicators on materials distributed to facilitate MCE selection. The State reserves the right to develop a rating system advertising Contractor performance on areas such as consumer satisfaction, network access and quality improvement. To facilitate State development of these materials, the Contractor shall comply with State requests for information needed to develop informational materials for potential members.
Member Enrollment. Velovita provides to its Member (i) a personalized marketing website that includes web hosting and (ii) the V-Cloud administrative tools that enable the Member to manage his/ her business, view online tools, review the calculation and payment of commissions, and access previous records of Member purchases. When a Member elects to enroll with the Velovita V-Cloud at an annual cost of forty- nine dollars and ninety-five cents ($49.95 USD), such Member will have unlimited access to his/her V-Cloud management software for one year from the date of purchase. This amount will be refunded only if the Member resigns within the first 30 (thirty) days after the registration purchase.
Member Enrollment. (A) Maximum Medicaid Enrollment HSD and the CONTRACTOR may mutually agree in writing to establish a maximum Medicaid enrollment level for Members, which may vary throughout the term of this Agreement. The maximum Medicaid enrollment also may be established by HSD on a statewide or county-by-county basis based on the capacity of the CONTRACTOR’s provider network, or to ensure that the CONTRACTOR has the capacity to provide statewide Covered Services to its Members. Subsequent to the establishment of this limit, if the CONTRACTOR wishes to change its maximum enrollment level, the CONTRACTOR shall notify HSD in writing ninety (90) calendar days prior to the desired effective date of the proposed change. HSD shall approve all requests for changing maximum enrollment levels before implementation. Should a maximum enrollment level be reduced to below the actual enrollment level, HSD may disenroll Members to establish compliance with the new limit. HSD may reduce the maximum enrollment levels for reasons such as imposing a sanction for not having sufficient Network Providers to guarantee access, violating marketing regulations, or for a material breach of this Agreement.
Member Enrollment. Members will be eligible to enroll in the Everside Health Center upon the receipt by Everside of an Eligibility File from Client. During the Term of this Agreement and subject to Everside Health Center policies, an enrolled Member will remain enrolled in the Everside Health Center until Everside receives from Client notice that a Member has disenrolled for any reason and an Eligibility File that does not include such Member’s information. Client shall submit to Everside a current census of covered lives by the 7th calendar day of each month, listing those Members as of the 1st calendar day of the same month. Everside Responsibilities.
Member Enrollment. The State will monitor the MCO’s member enrollment in the mandatory RBMC counties and may limit the MCO’s member enrollment in a particular county (or counties), as described in Attachment F. Any member enrollment limitations that the State applies to the MCO is in the interest of protecting the mandatory status of the county by ensuring adequate member choice of health plans and will not limit or impede a member’s choice in PMP selection. HOOSIER HEALTHWISE STATE/MCO CONTRACT CONTRACT ATTACHMENT 1: MCO SCOPE OF WORK The State requires the MCO to accept as enrolled all individuals appearing on the enrollment rosters or enrollees for whom the MCO receives capitation payment. The MCO and rendering provider are responsible for verifying the member’s eligibility. If an MCO receives either enrollment information or capitation for a member, the MCO is financially responsible for the member. Hoosier Healthwise members selecting a PMP contracted with the MCO will become enrolled members with the same MCO until that PMP no longer contracts with the MCO or the member changes his/her PMP. In accordance with 42 CFR 438.56, Sections (c), (d) and (e), the MCO must have policies and procedures that allow members to change their PMPs.
Member Enrollment. The Contractor shall:
Member Enrollment. The Contractor shall ensure that all eligible persons who receive Covered Services are enrolled in the RBHA Information System in a timely manner and in accordance to RBHA policy.
