Notification of Enrollee Rights Clause Samples
The Notification of Enrollee Rights clause requires that individuals enrolled in a program or plan are informed of their legal rights and entitlements. Typically, this involves providing written or electronic notices that outline the enrollee’s rights to appeal decisions, access services, or file complaints, often at the time of enrollment or when changes occur. By mandating clear communication of these rights, the clause ensures transparency and empowers enrollees to make informed decisions and seek recourse if their rights are not upheld.
Notification of Enrollee Rights. The Contractor agrees to make all reasonable efforts to contact new Enrollees, in person, by telephone, or by mail, within thirty (30) days of their Effective Date of Enrollment. "Reasonable efforts" are defined to mean at least three (3) attempts, with more than one method of contact being employed. Upon contacting the new Enrollee(s), the Contractor agrees to do at least the following:
a) Inform the Enrollee about the Contractor's policies with respect to obtaining medical services, including services for which the Enrollee may self-refer, and what to do in an emergency.
b) Conduct a brief health screening to assess the Enrollee's need for any special health care (e.g., prenatal or behavioral health services) or language/communication needs. If a special need is identified, the Contractor shall assist the Enrollee in arranging for an appointment with his/her PCP or other appropriate provider.
c) Offer assistance in arranging an initial visit to the Enrollee's PCP for a baseline physical and other preventive services, including an assessment of the Enrollee's potential risk, if any, for specific diseases or conditions.
d) Inform new Enrollees about their rights for continuation of certain existing services.
e) Provide the Enrollee with the Contractor's toll free telephone number that may be called twenty-four (24) hours a day, seven (7) days a week if the Enrollee has questions about obtaining services and cannot reach his/her PCP (this telephone number need not be the Member Services line and need not be staffed to respond to Member Services-related inquiries). The Contractor must have appropriate mechanisms in place to accommodate Enrollees who do not have telephones and therefore cannot readily receive a call back.
f) Advise Enrollee about opportunities available to learn about MCO policies and benefits in greater detail (e.g., welcome meeting, Enrollee orientation and education sessions).
g) Provide the Enrollee with a complete list of network providers that may be accessed directly, without referral. The list should group providers by service type and must include addresses and telephone numbers.
h) Assist the Enrollee in selecting a primary care provider if one has not already been chosen.
Notification of Enrollee Rights. The Contractor agrees to make all reasonable efforts to contact new Enrollees, in person, by telephone, or by mail, within thirty (30) days of their Effective Date of Enrollment. "Reasonable efforts" are defined to mean at least three (3) attempts, with more than one method of contact being employed. Upon contacting the new Enrollee(s), the Contractor agrees to do at least the following:
a) Inform the Enrollee about the Contractor's policies with respect to obtaining medical services, including services for which the Enrollee may self-refer, and what to do in an emergency.
b) Conduct a brief health screening to assess the Enrollee's need for any special health care (e.g., prenatal or behavioral health services) or language/communication needs. If a special need is identified, the Contractor shall assist the Enrollee in arranging for an appointment with his/her PCP or other appropriate provider.
Notification of Enrollee Rights. The Contractor agrees to make all reasonable efforts to contact new Enrollees, in person, by telephone, or by mail within thirty (30) days of their Effective Date of Enrollment. "
Notification of Enrollee Rights a) The Contractor agrees to make aggressive efforts as necessary to contact new Enrollees, in person, by telephone, or by mail within thirty (30) days of their Effective Date of Enrollment. Aggressive efforts are defined to mean at least six attempts including a home visit to contact the individual. Upon contacting the new Enrollee(s), the Contractor agrees to do at least the following:
i) Inform the Enrollee about the Contractor's policies with respect to obtaining Benefit Package services, including services for which the Enrollee may self-refer, pursuant to Section 10.19 of this Agreement, procedures for obtaining standing referrals, the use of specialty care centers, the use of a specialist as primary care provider, and what to do in an emergency. The Contractor must also inform the Enrollee regarding any exceptions in effect to the travel time/distance standards to HIV Specialist PCP sites in certain counties as described in Section 15.6 (b) of this Agreement.
ii) Conduct a brief health screening to assess the Enrollee's need for any special health care (e.g., prenatal or behavioral health services) or language/communication needs. If a special need is identified, the Contractor shall assist the Enrollee in arranging for an appointment with his/her PCP or other appropriate provider on a timely basis.
iii) Provide all new Enrollees with information regarding basic primary and preventive services specific to the care, treatment, and prevention of HIV infection, as well as the advantages of new treatment regimens and therapies and information on different primary care options, if available, such as those that provide co-located primary care and substance abuse services.
iv) Offer assistance in arranging an initial visit to the Enrollee's PCP for a baseline physical and other preventive services, including a comprehensive risk assessment.
v) Inform new Enrollees about their rights for continuation of certain existing services.
vi) Provide Enrollees information on Contractor’s HIV SNP Care and Benefit Coordination Services and how to access medical and non-medical support services such as HIV counseling, testing, referral, and partner notification, nutrition, and housing assistance.
vii) Provide the Enrollee with the Contractor's toll free telephone number that may be called twenty-four (24) hours a day, seven (7) days a week if the Enrollee has questions about obtaining services and cannot reach his/her PCP (this telephone number need not be the Member Se...