Member Handbooks Sample Clauses
The Member Handbooks clause establishes the requirement for the organization to provide members with a handbook outlining key policies, procedures, and expectations. Typically, this handbook covers topics such as codes of conduct, membership benefits, disciplinary processes, and operational guidelines, ensuring that all members have access to consistent information. By formalizing the distribution and content of member handbooks, this clause helps prevent misunderstandings and promotes transparency within the organization.
Member Handbooks. The Contractor shall issue to a new Enrollee within fourteen (14) days of the Effective Date of Enrollment a Member Handbook, which is consistent with the SDOH guidelines described in Appendix E, which is hereby made a part of this Agreement as if set forth fully herein.
Member Handbooks. 2.17.4.1 The CONTRACTOR shall develop a member handbook based on a template provided by TENNCARE, and update it periodically (at least annually). Upon notice to TENNCARE of material changes to the member handbook, the CONTRACTOR shall make appropriate revisions and immediately distribute the revised handbook to members and providers.
2.17.4.2 The CONTRACTOR shall distribute member handbooks to members within thirty (30) calendar days of receipt of notice of enrollment in the CONTRACTOR’s MCO or prior to enrollees’ enrollment effective date as described in Section 2.4.5 and at least annually thereafter. In the event of material revisions to the member handbook, the CONTRACTOR shall distribute the new and revised handbook to all members immediately.
2.17.4.3 In situations where there is more than one member in a TennCare case, it shall be acceptable for the CONTRACTOR to mail one (1) member handbook to each address listed for the member’s TennCare case number when there is more than one (1) new enrollee assigned to the same case number at the time of enrollment and when subsequent new or updated member handbooks are mailed to members. Should a single individual be enrolled and be added into an existing case, a member handbook (new or updated) must be mailed to that individual regardless of whether or not a member handbook has been previously mailed to members in the existing case.
2.17.4.4 The CONTRACTOR shall distribute a member handbook to all contract providers upon initial credentialing, annually thereafter as handbooks are updated, and whenever there are material revisions. For purposes of providing member handbooks to providers, it shall be acceptable to provide handbooks in electronic format, including but not limited to CD or access via a web link.
2.17.4.5 Each member handbook shall, at a minimum, be in accordance with the following guidelines:
2.17.4.5.1 Must be in accordance with all applicable requirements as described in Section 2.17.2 of this Agreement;
2.17.4.5.2 Shall include a table of contents;
2.17.4.5.3 Shall include an explanation on how members will be notified of member specific information such as effective date of enrollment;
2.17.4.5.4 Shall include a description of services provided including benefit limits and thresholds, including how reaching service thresholds may trigger enrollment in MCO case management or disease management, exclusions, and use of non-contract providers;
2.17.4.5.5 Shall include descriptions of both the Medi...
Member Handbooks. Member handbooks must include, at a minimum, the following information:
a. Names, locations, telephone numbers of, and non-English languages spoken by current contracted providers in the enrollee’s service area, including identification of providers that are not accepting new patients;
b. Any restrictions on the enrollee’s freedom of choice among CCN providers;
Member Handbooks. The Contractor shall issue to a new Enrollee no later than fourteen (14) days following the Effective Date of Enrollment a Medicaid Advantage Member Handbook, which is approved by SDOH and consistent with the Medicaid Advantage Model Handbook Guidelines in Appendix E, which is hereby made a part of this Agreement as if set forth fully herein.
Member Handbooks. For all populations eligible for services under this Contract, the Contractor shall:
11.2.1 Print and distribute Member Handbooks in conformance with the Contractor‘s established procedures and ADHS/DBHS Policy on the Member Handbook; (42 CFR 438.10(f)).
11.2.2 Submit the Contractor‘s Member Handbook to ADHS/DBHS for approval within thirty (30) days of receiving the ADHS/DBHS Template, unless otherwise specified.
11.2.3 Provide the Contractor‘s Member Handbook to each member as follows: For Non-Title XIX/XXI members or Title XIX/XXI members enrolled with an AHCCCS Health Plan, within twelve (12) business days of the member receiving the initial behavioral health covered service; and For SMI members receiving physical health care services from Contractor, within twelve