{"component": "clause", "props": {"groups": [{"samples": [{"hash": "l8TIMM3H75O", "uri": "/contracts/l8TIMM3H75O#reenrollment", "label": "Contract for Medical Services", "score": 25.0602321625, "published": true}, {"hash": "35uqLloWXCW", "uri": "/contracts/35uqLloWXCW#reenrollment", "label": "Contract for Medical Services", "score": 24.9835720062, "published": true}, {"hash": "dMTLX3WZZFl", "uri": "/contracts/dMTLX3WZZFl#reenrollment", "label": "Contract for Medical Services", "score": 24.7180023193, "published": true}], "snippet_links": [{"key": "the-department", "type": "clause", "offset": [0, 14]}, {"key": "enrollment-broker", "type": "definition", "offset": [17, 34]}, {"key": "previously-enrolled", "type": "clause", "offset": [65, 84]}, {"key": "medicaid-managed-care", "type": "definition", "offset": [85, 106]}, {"key": "eligibility-for-a", "type": "clause", "offset": [173, 190]}, {"key": "period-of", "type": "definition", "offset": [191, 200]}], "snippet": "The Department\u2019s Enrollment broker will automatically reenroll a previously enrolled Medicaid Managed Care Member who was Disenrolled solely because he or she lost Medicaid eligibility for a period of two (2) months or less.", "size": 20, "hash": "073efea3e99ec6fd674fc647ed733f68", "id": 1}, {"samples": [{"hash": "6EzWoMGL4Nr", "uri": "/contracts/6EzWoMGL4Nr#reenrollment", "label": "Contract for Medical Assistance and Minnesotacare Services", "score": 24.0540733337, "published": true}, {"hash": "khQkDI2bIEn", "uri": "/contracts/khQkDI2bIEn#reenrollment", "label": "Contract for Medical Assistance and Minnesotacare Services", "score": 22.5112934113, "published": true}, {"hash": "aJ1vRQxkYsb", "uri": "/contracts/aJ1vRQxkYsb#reenrollment", "label": "Contract for Medical Assistance and Minnesotacare Services", "score": 22.5112934113, "published": true}], "snippet_links": [{"key": "for-any-reason", "type": "clause", "offset": [30, 44]}, {"key": "the-state-shall", "type": "clause", "offset": [90, 105]}, {"key": "a-change-in", "type": "definition", "offset": [174, 185]}, {"key": "in-accordance-with", "type": "definition", "offset": [191, 209]}, {"key": "section-32", "type": "definition", "offset": [228, 239]}, {"key": "primary-care-provider", "type": "definition", "offset": [307, 328]}], "snippet": "If an Enrollee is disenrolled for any reason and subsequently becomes eligible to enroll, the STATE shall reenroll the Enrollee in the same MCO, unless the Enrollee requests a change in MCOs in accordance with section 3.5.14 or section 3.2. In no circumstance shall the MCO randomly assign an Enrollee to a Primary Care Provider upon reenrollment.", "size": 10, "hash": "68a2e72eb3da199d9d75debc469c5330", "id": 2}, {"samples": [{"hash": "i69r3zXLTvQ", "uri": "/contracts/i69r3zXLTvQ#reenrollment", "label": "Contract for Badgercare Plus and/or Medicaid Ssi Hmo Services", "score": 24.7563304901, "published": true}, {"hash": "hzqkwcn85Z4", "uri": "/contracts/hzqkwcn85Z4#reenrollment", "label": "Contract for Badgercare Plus and/or Medicaid Ssi Hmo Services", "score": 24.5167694092, "published": true}, {"hash": "lo8zc4Ho2jK", "uri": "/contracts/lo8zc4Ho2jK#reenrollment", "label": "Contract for Badgercare Plus and/or Medicaid Ssi Hmo Services", "score": 24.1704311371, "published": true}], "snippet_links": [{"key": "a-member", "type": "clause", "offset": [0, 8]}, {"key": "badgercare-plus", "type": "definition", "offset": [107, 122]}, {"key": "medicaid-ssi", "type": "clause", "offset": [130, 142]}, {"key": "eligibility-for-a", "type": "clause", "offset": [143, 160]}, {"key": "period-of", "type": "definition", "offset": [161, 170]}, {"key": "six-months-or-less", "type": "clause", "offset": [171, 189]}], "snippet": "A member may be automatically reenrolled into the HMO if they were disenrolled solely because she/he loses BadgerCare Plus and/or Medicaid SSI eligibility for a period of six months or less.", "size": 6, "hash": "ec5c612883e2eff87b849ccb2d56fad8", "id": 3}, {"samples": [{"hash": "6n3EWOaaFO3", "uri": "/contracts/6n3EWOaaFO3#reenrollment", "label": "Collective Bargaining Agreement", "score": 20.2114982605, "published": true}, {"hash": "ay1byUCTChd", "uri": "/contracts/ay1byUCTChd#reenrollment", "label": "Collective Bargaining Agreement", "score": 19.0, "published": true}, {"hash": "1UgGgZdVeXK", "uri": "/contracts/1UgGgZdVeXK#reenrollment", "label": "Collective Bargaining Agreement", "score": 19.0, "published": true}], "snippet_links": [{"key": "the-district", "type": "clause", "offset": [45, 57]}, {"key": "health-insurance-plan", "type": "definition", "offset": [60, 81]}, {"key": "open-enrollment-periods", "type": "clause", "offset": [100, 123]}, {"key": "written-request", "type": "definition", "offset": [129, 144]}, {"key": "to-the-superintendent", "type": "clause", "offset": [145, 166]}, {"key": "in-the-event-of", "type": "definition", "offset": [168, 183]}, {"key": "date-of", "type": "clause", "offset": [258, 265]}, {"key": "an-annual", "type": "clause", "offset": [318, 327]}, {"key": "business-days-of", "type": "clause", "offset": [415, 431]}], "snippet": "Participating Administrators may reenroll in the District\u2019s health insurance plan during designated open enrollment periods upon written request to the Superintendent. In the event of reenrollment, the amount of the opt-out payment will be prorated from the date of the opt-out to the date of reenrollment, based upon an annual opt-out payment figure of $2,000.00. Prorated payment will be made within fifteen (15) business days of the date of reenrollment.", "size": 5, "hash": "02a67edbcfd5cc7a1eb57be84605bf4a", "id": 4}, {"samples": [{"hash": "hTBD0keFR1p", "uri": "/contracts/hTBD0keFR1p#reenrollment", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "dFsL10KgbAi", "uri": "/contracts/dFsL10KgbAi#reenrollment", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "bYUtCgouXEp", "uri": "/contracts/bYUtCgouXEp#reenrollment", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}], "snippet_links": [{"key": "a-member", "type": "clause", "offset": [0, 8]}, {"key": "the-member", "type": "definition", "offset": [49, 59]}, {"key": "medical-assistance", "type": "definition", "offset": [84, 102]}, {"key": "persons-eligible-for-enrollment", "type": "clause", "offset": [159, 190]}, {"key": "in-the-same-manner", "type": "definition", "offset": [251, 269]}, {"key": "initial-enrollment", "type": "definition", "offset": [276, 294]}, {"key": "previously-enrolled", "type": "clause", "offset": [305, 324]}, {"key": "the-contractor-shall", "type": "clause", "offset": [330, 350]}, {"key": "eligibility-for", "type": "clause", "offset": [402, 417]}, {"key": "enrollment-date", "type": "definition", "offset": [536, 551]}, {"key": "all-purposes", "type": "clause", "offset": [699, 711]}], "snippet": "A Member whose eligibility is terminated because the Member no longer qualifies for medical assistance under one of the aid categories listed in Section 27.8 \u201cPersons Eligible for Enrollment\u201d or otherwise becomes ineligible may apply for reenrollment in the same manner as an initial enrollment. A Member previously enrolled with the Contractor shall be automatically reenrolled with the Contractor if eligibility for medical assistance is re-established within two (2) months of losing eligibility. The Contractor shall be given a new enrollment date once a Member has been reinstated. Reenrollment that is more than two (2) months after losing eligibility shall be treated as a new enrollment for all purposes.", "size": 4, "hash": "6cb8cea7dc767f730b3f4fd12e1dedd0", "id": 5}, {"samples": [{"hash": "9BjUeQG318H", "uri": "/contracts/9BjUeQG318H#reenrollment", "label": "Special Terms and Conditions", "score": 23.3195667267, "published": true}, {"hash": "3xeLY7blSh3", "uri": "/contracts/3xeLY7blSh3#reenrollment", "label": "Special Terms and Conditions", "score": 23.3195667267, "published": true}, {"hash": "k9PHmy9orES", "uri": "/contracts/k9PHmy9orES#reenrollment", "label": "Special Terms and Conditions", "score": 21.5229301453, "published": true}], "snippet_links": [{"key": "application-for-enrollment", "type": "clause", "offset": [41, 67]}, {"key": "upon-receiving", "type": "clause", "offset": [80, 94]}, {"key": "termination-notice", "type": "definition", "offset": [95, 113]}, {"key": "the-state", "type": "clause", "offset": [128, 137]}, {"key": "waiting-list", "type": "definition", "offset": [156, 168]}, {"key": "open-enrollment", "type": "definition", "offset": [330, 345]}, {"key": "the-beneficiaries", "type": "clause", "offset": [377, 394]}], "snippet": "A disenrolled beneficiary may make a new application for enrollment immediately upon receiving termination notice. In the event the state has implemented a waiting list, any disenrolled beneficiary who reapplies will be placed on the waiting list and notified once the state is open to their enrollment. When the state is able to open enrollment for those on the waiting list, the beneficiaries\u2019 eligibility will be processed in the order they were placed on the waiting list.", "size": 4, "hash": "be932b301b5aca065f26cbb69275ce11", "id": 6}, {"samples": [{"hash": "13r9f2IcNsf", "uri": "/contracts/13r9f2IcNsf#reenrollment", "label": "Card Security Debt Cancellation Program Agreement", "score": 33.830039978, "published": true}, {"hash": "k5PU0t5bxdq", "uri": "/contracts/k5PU0t5bxdq#reenrollment", "label": "Card Security Debt Cancellation Program Agreement", "score": 32.6885604858, "published": true}, {"hash": "1wBuYNs5Bcq", "uri": "/contracts/1wBuYNs5Bcq#reenrollment", "label": "Card Security Debt Cancellation Program Agreement", "score": 27.7010765076, "published": true}], "snippet_links": [{"key": "this-agreement", "type": "clause", "offset": [3, 17]}, {"key": "the-program", "type": "clause", "offset": [65, 76]}, {"key": "new-enrollment", "type": "clause", "offset": [103, 117]}], "snippet": "If this Agreement is ended, You will not be able to take part in the Program again unless You submit a new enrollment request and We approve it.", "size": 3, "hash": "733f12542fa835a773c710dc2a1bc34e", "id": 7}, {"samples": [{"hash": "9UBW2v70bYg", "uri": "/contracts/9UBW2v70bYg#reenrollment", "label": "State Buy in Agreement", "score": 31.1412410736, "published": true}], "snippet_links": [{"key": "for-an-individual", "type": "clause", "offset": [0, 17]}, {"key": "april-1", "type": "definition", "offset": [40, 47]}, {"key": "the-period", "type": "clause", "offset": [112, 122]}, {"key": "number-of-months", "type": "definition", "offset": [160, 176]}, {"key": "the-individual", "type": "clause", "offset": [208, 222]}, {"key": "enrollment-period", "type": "definition", "offset": [235, 252]}, {"key": "period-of-coverage", "type": "definition", "offset": [401, 419]}, {"key": "subsequent-period", "type": "clause", "offset": [547, 564]}, {"key": "enrollment-limitation", "type": "clause", "offset": [853, 874]}, {"key": "in-effect", "type": "definition", "offset": [875, 884]}], "snippet": "For an individual who reenrolled before April 1, 1981, or after September 30, 1981, and before January 1, 2023, the period\u2014\n(1) Includes the following:\n(i) The number of months elapsed be- tween the close of the individual\u2019s ini- tial enrollment period and the close of the enrollment period in which he or she first enrolled; plus\n(ii) The number of months elapsed be- tween the individual\u2019s initial period of coverage and the close of the enroll- ment period in which he or she re- enrolled; plus\n(iii) The number of months elapsed between each subsequent period of cov- erage and the close of the enrollment period in which he or she reenrolled.\n(2) Excludes the following:\n(i) Any of the periods specified in paragraph (a) of this section; and\n(ii) Any month before April 1981 dur- ing which the individual was precluded from reenrolling by the two-enrollment limitation in effect before that date.", "size": 1, "hash": "f0650b533f403fc39696e8f47f6e43b1", "id": 8}, {"samples": [{"hash": "3lDOtumFyQW", "uri": "/contracts/3lDOtumFyQW#reenrollment", "label": "Contract for Medical Services", "score": 24.1704311371, "published": true}], "snippet_links": [{"key": "enrollment-broker", "type": "definition", "offset": [17, 34]}, {"key": "previously-enrolled", "type": "clause", "offset": [65, 84]}, {"key": "medicaid-managed-care", "type": "definition", "offset": [85, 106]}, {"key": "eligibility-for-a", "type": "clause", "offset": [173, 190]}, {"key": "period-of", "type": "definition", "offset": [191, 200]}, {"key": "member-enrollment", "type": "clause", "offset": [233, 250]}, {"key": "the-contractor-shall", "type": "clause", "offset": [251, 271]}, {"key": "by-the-department", "type": "clause", "offset": [336, 353]}, {"key": "authorized-by", "type": "definition", "offset": [372, 385]}, {"key": "consistent-with-the", "type": "clause", "offset": [405, 424]}, {"key": "in-this-contract", "type": "clause", "offset": [445, 461]}, {"key": "policy-and-procedure", "type": "definition", "offset": [483, 503]}, {"key": "discontinuation-of-enrollment", "type": "clause", "offset": [529, 558]}, {"key": "suspension-of-enrollment", "type": "clause", "offset": [559, 583]}, {"key": "new-enrollment", "type": "clause", "offset": [611, 625]}, {"key": "auto-assignment", "type": "clause", "offset": [633, 648]}, {"key": "corrective-action-plan", "type": "definition", "offset": [728, 750]}, {"key": "in-accordance-with", "type": "definition", "offset": [751, 769]}, {"key": "section-18", "type": "definition", "offset": [770, 780]}, {"key": "the-department-will", "type": "clause", "offset": [812, 831]}, {"key": "a-contractor", "type": "clause", "offset": [865, 877]}, {"key": "health-plan", "type": "definition", "offset": [880, 891]}, {"key": "notice-to", "type": "definition", "offset": [910, 919]}, {"key": "geographic-service-area", "type": "definition", "offset": [936, 959]}, {"key": "terminate-the-contract", "type": "clause", "offset": [963, 985]}, {"key": "section-17", "type": "clause", "offset": [1005, 1015]}, {"key": "the-department-shall", "type": "clause", "offset": [1034, 1054]}, {"key": "date-of", "type": "clause", "offset": [1090, 1097]}, {"key": "the-notice", "type": "clause", "offset": [1098, 1108]}, {"key": "by-the-contractor", "type": "clause", "offset": [1119, 1136]}, {"key": "receiving-member", "type": "definition", "offset": [1276, 1292]}, {"key": "approval-by", "type": "clause", "offset": [1318, 1329]}, {"key": "not-limited", "type": "clause", "offset": [1463, 1474]}, {"key": "new-members", "type": "clause", "offset": [1478, 1489]}, {"key": "request-in-writing", "type": "clause", "offset": [1548, 1566]}, {"key": "in-advance", "type": "clause", "offset": [1592, 1602]}, {"key": "enrollment-limit", "type": "clause", "offset": [1651, 1667]}, {"key": "the-request", "type": "clause", "offset": [1676, 1687]}, {"key": "effective-period", "type": "definition", "offset": [1701, 1717]}, {"key": "a-member", "type": "clause", "offset": [1905, 1913]}, {"key": "department-or", "type": "definition", "offset": [2011, 2024]}, {"key": "responsible-for", "type": "clause", "offset": [2041, 2056]}, {"key": "at-any-time", "type": "clause", "offset": [2249, 2260]}, {"key": "in-section-3", "type": "clause", "offset": [2306, 2318]}, {"key": "effective-date", "type": "definition", "offset": [2427, 2441]}, {"key": "day-of", "type": "clause", "offset": [2511, 2517]}, {"key": "following-the", "type": "definition", "offset": [2535, 2548]}, {"key": "medicaid-mco", "type": "definition", "offset": [2568, 2580]}, {"key": "disenrollment-requests-for-cause", "type": "clause", "offset": [2831, 2863]}, {"key": "of-the-contractor", "type": "clause", "offset": [3070, 3087]}, {"key": "contract-termination", "type": "clause", "offset": [3104, 3124]}, {"key": "related-services", "type": "clause", "offset": [3212, 3228]}, {"key": "for-example", "type": "definition", "offset": [3230, 3241]}, {"key": "tubal-ligation", "type": "clause", "offset": [3268, 3282]}, {"key": "provider-network", "type": "clause", "offset": [3368, 3384]}, {"key": "primary-care-provider", "type": "definition", "offset": [3405, 3426]}, {"key": "the-services", "type": "clause", "offset": [3473, 3485]}, {"key": "for-members", "type": "clause", "offset": [3545, 3556]}, {"key": "long-term-care", "type": "clause", "offset": [3574, 3588]}, {"key": "support-services", "type": "definition", "offset": [3589, 3605]}, {"key": "employment-supports", "type": "definition", "offset": [3686, 3705]}, {"key": "based-on", "type": "definition", "offset": [3715, 3723]}, {"key": "change-in-status", "type": "clause", "offset": [3740, 3756]}, {"key": "network-provider", "type": "definition", "offset": [3789, 3805]}, {"key": "the-plan", "type": "clause", "offset": [3866, 3874]}, {"key": "moral-or-religious-objections", "type": "clause", "offset": [3896, 3925]}, {"key": "other-acceptable-reasons", "type": "clause", "offset": [3965, 3989]}, {"key": "other-reasons", "type": "definition", "offset": [3990, 4003]}, {"key": "approved-by", "type": "definition", "offset": [4008, 4019]}, {"key": "quality-of-care", "type": "clause", "offset": [4100, 4115]}, {"key": "access-to", "type": "definition", "offset": [4129, 4138]}, {"key": "core-benefits", "type": "definition", "offset": [4139, 4152]}, {"key": "dealing-with", "type": "clause", "offset": [4204, 4216]}, {"key": "care-needs", "type": "definition", "offset": [4237, 4247]}, {"key": "appropriate-form", "type": "definition", "offset": [4346, 4362]}, {"key": "to-the-member", "type": "clause", "offset": [4363, 4376]}, {"key": "prior-to", "type": "clause", "offset": [4443, 4451]}, {"key": "initial-processing", "type": "definition", "offset": [4511, 4529]}, {"key": "right-to-appeal", "type": "clause", "offset": [4623, 4638]}, {"key": "adverse-decision", "type": "clause", "offset": [4643, 4659]}, {"key": "member-disenrollment-requests-without-cause", "type": "clause", "offset": [4661, 4704]}, {"key": "days-after", "type": "definition", "offset": [4918, 4928]}, {"key": "initial-enrollment", "type": "definition", "offset": [4942, 4960]}, {"key": "automatic-reinstatement", "type": "clause", "offset": [4997, 5020]}, {"key": "intermediate-sanction", "type": "definition", "offset": [5190, 5211]}, {"key": "contractor-disenrollment-requests-the-contractor", "type": "clause", "offset": [5275, 5323]}, {"key": "member-dies", "type": "clause", "offset": [5522, 5533]}, {"key": "inmate-of-a-public-institution", "type": "definition", "offset": [5557, 5587]}, {"key": "out-of-state", "type": "clause", "offset": [5606, 5618]}, {"key": "ltc-facility", "type": "definition", "offset": [5721, 5733]}, {"key": "nursing-home", "type": "definition", "offset": [5734, 5746]}, {"key": "consecutive-days", "type": "definition", "offset": [5773, 5789]}, {"key": "home-and-community", "type": "clause", "offset": [5811, 5829]}, {"key": "waiver-program", "type": "definition", "offset": [5852, 5866]}, {"key": "age-65", "type": "clause", "offset": [5887, 5893]}, {"key": "ability-to", "type": "clause", "offset": [6004, 6014]}, {"key": "services-to-the", "type": "clause", "offset": [6023, 6038]}, {"key": "out-of-home", "type": "clause", "offset": [6094, 6105]}, {"key": "intermediate-care-facility", "type": "definition", "offset": [6113, 6139]}, {"key": "for-individuals", "type": "definition", "offset": [6140, 6155]}, {"key": "south-carolina", "type": "definition", "offset": [6236, 6250]}, {"key": "for-review", "type": "clause", "offset": [6432, 6442]}, {"key": "additional-information-and-documentation", "type": "clause", "offset": [6479, 6519]}, {"key": "such-information", "type": "definition", "offset": [6565, 6581]}, {"key": "adverse-change", "type": "definition", "offset": [6643, 6657]}, {"key": "health-status", "type": "definition", "offset": [6674, 6687]}, {"key": "medical-services", "type": "definition", "offset": [6717, 6733]}, {"key": "mental-capacity", "type": "definition", "offset": [6759, 6774]}, {"key": "disruptive-behavior", "type": "definition", "offset": [6796, 6815]}, {"key": "resulting-from", "type": "definition", "offset": [6816, 6830]}, {"key": "special-needs", "type": "definition", "offset": [6842, 6855]}, {"key": "an-exception", "type": "clause", "offset": [6857, 6869]}, {"key": "other-members", "type": "definition", "offset": [7046, 7059]}], "snippet": "The Department\u2019s Enrollment broker will automatically reenroll a previously enrolled Medicaid Managed Care Member who was Disenrolled solely because he or she lost Medicaid eligibility for a period of two (2) months or less. Maximum Member Enrollment The CONTRACTOR shall: Accept Members in the order in which they apply, as determined by the Department, up to the limits authorized by the Department and consistent with the processes specified in this contract and the Managed Care Policy and Procedure Guide. Suspension and/or Discontinuation of Enrollment Suspension of Enrollment The Department may suspend new Enrollment and/or auto assignment when the Department has imposed a sanction or the CONTRACTOR is placed under a Corrective Action Plan in accordance with Section 18. Discontinuation of Enrollment The Department will discontinue all Enrollments into a CONTRACTOR\u2019s Health Plan that has provided notice to withdraw from a Geographic Service Area or terminate the contract in accordance with Section 17 of this contract. The Department shall discontinue all Enrollments on the date of the notice submitted by the CONTRACTOR or on the earliest possible date by which such Enrollments can be discontinued. Requests to Discontinue Enrollment Requests to discontinue receiving Member Enrollment is subject to approval by the Department and any approval will result in the discontinuation of all Enrollments in the CONTRACTOR\u2019s Health Plan, including but not limited to new Members and Member reinstatements. The CONTRACTOR shall: Submit a request in writing at least sixty (60) Days in advance when the CONTRACTOR has not reached its maximum Enrollment limit. Ensure the request contains the effective period of the request Ensure the request includes the reason for the request. Member Disenrollment Disenrollments may be initiated by: (1) the Member, (2) the Department, or (3) the CONTRACTOR. A Member may be Disenrolled from the CONTRACTOR\u2019s Health Plan only when authorized by the Department. The Department or its designee is responsible for any Disenrollment action to remove a Member from the CONTRACTOR\u2019s Health Plan. Member Disenrollment Requests A Member may request Disenrollment from the CONTRACTOR\u2019s Health Plan (1) for cause at any time, or (2) without cause for the reasons listed in Section 3 of this contract. All Member requests for Disenrollment must be referred to the Department or its designee. Effective date of an approved Disenrollment request must be no later than the first day of the second month following the month in which the Medicaid MCO Member filed the request. A Member\u2019s request to Disenroll must be acted on by the Department no later than the first day of the second month following the month in which the Member filed the request. If not, the request shall be considered approved. Disenrollment Requests For Cause A Member may request Disenrollment from the CONTRACTOR\u2019s health plan for cause at any time. The following are considered acceptable for-cause Disenrollments: Change in Member Residence The Member moves out of the CONTRACTOR\u2019s Service Area, Contract Termination The CONTRACTOR or the Department has terminated the contract, The member is in need of related services (for example, a Cesarean Section and a tubal ligation) to be performed at the same time; not all related services are available within the Provider network; and the Enrollee's primary care Provider or another Provider determines that receiving the services separately would subject the Enrollee to unnecessary risk. For members that use Managed Long Term Care Support Services (MLTSS), the Enrollee would have to change their residential, institutional, or employment supports Provider based on that Provider's change in status from an in-network to an out-of-network Provider with the CONTRACTOR. Members may Disenroll without cause if the Plan does not, because of moral or religious objections, cover the service the Enrollee seeks. Other Acceptable Reasons Other reasons, as approved by the Department on a case by case basis, including, but not limited to: (a) poor quality of care; (b) lack of access to Core Benefits; or (c) lack of access to Providers experienced in dealing with the Member\u2019s health care needs. For cause Disenrollment requests must be initiated with the Enrollment broker, who will send the appropriate form to the Member for completion. The Member is required to contact the Health Plan prior to submitting the completed form to the Enrollment broker for initial processing. All Disenrollment for cause decisions are made by the Department. The Member shall have the right to Appeal any adverse decision. Member Disenrollment Requests Without Cause A Member may request Disenrollment from the CONTRACTOR\u2019s Health Plan without cause. The Department will only grant Disenrollment without cause for the following reasons: The request is received within ninety (90) Days after the Member\u2019s initial Enrollment in a CONTRACTOR\u2019s Health Plan. Upon automatic reinstatement into a Health Plan if the Member regained Medicaid eligibility within sixty (60) Days. At least once every twelve (12) months thereafter; When the Department imposes an intermediate sanction specified in 42 CFR \u00a7 438.702 and Section 18 of this contract. CONTRACTOR Disenrollment Requests The CONTRACTOR: May request Member Disenrollment for the following reasons: The CONTRACTOR terminates the contract with the Department, The CONTRACTOR discontinues operations within the Member's Service Area, The Member dies, The Member becomes an Inmate of a public institution, The Member moves out of state or the CONTRACTOR\u2019s Service Area, The Member elects hospice The Member becomes institutionalized in a LTC Facility/Nursing Home for more than ninety (90) consecutive Days, The Member elects a Home and Community-Based Services (HCBS) waiver program, The Member becomes age 65 or older, The Member\u2019s behavior is disruptive, unruly, abusive, or uncooperative and impairs the CONTRACTOR\u2019s ability to furnish services to the Member or other enrolled Members, The Member is placed out of home [i.e., Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), Must submit the request in writing to South Carolina Healthy Connections Choices (SCHCC). Must include a sufficient amount of detail regarding the reason for Disenrollment. SCHCC will log this request and forward it to the Department for review, approval/disapproval. Must provide additional information and documentation to the Department if the Department requests such information. May not request Disenrollment for the following reasons: An adverse change in the Member\u2019s health status, The Member\u2019s utilization of medical services, The Member\u2019s diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her special needs. An exception exist when the Member\u2019s continued Enrollment in the CONTRACTOR\u2019s Health Plan seriously impairs the CONTRACTOR\u2019s ability to furnish services to either this particular Member or other Members.", "size": 1, "hash": "5d4ba67c2ab77677d10dbe2a3709b53d", "id": 9}, {"samples": [{"hash": "aIOGhsJQnki", "uri": "/contracts/aIOGhsJQnki#reenrollment", "label": "401(k) Plan Trust Agreement (Green Tree Financial Corp)", "score": 18.0, "published": true}], "snippet_links": [{"key": "october-1", "type": "definition", "offset": [10, 19]}, {"key": "the-third-sentence", "type": "clause", "offset": [27, 45]}, {"key": "section-774", "type": "clause", "offset": [49, 62]}, {"key": "plan-statement", "type": "definition", "offset": [70, 84]}, {"key": "the-participant", "type": "clause", "offset": [142, 157]}, {"key": "the-committee", "type": "clause", "offset": [193, 206]}, {"key": "effective-as-of-the", "type": "clause", "offset": [254, 273]}, {"key": "enrollment-date", "type": "definition", "offset": [308, 323]}, {"key": "employment-on", "type": "clause", "offset": [407, 420]}], "snippet": "Effective October 1, 1992, the third sentence of Section 7.7.4 of the Plan Statement shall be amended to read in full as follows: Thereafter, the Participant may, upon giving written notice to the Committee, enter into a new Retirement Savings Agreement effective as of the payday on or after any subsequent Enrollment Date following such twelve (12) month period, provided the Participant is in Recognized Employment on that date.", "size": 1, "hash": "d7651a663349cdef7c454155acfa8724", "id": 10}], "next_curs": "ClUST2oVc35sYXdpbnNpZGVyY29udHJhY3RzcjELEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2IhVyZWVucm9sbG1lbnQjMDAwMDAwMGEMogECZW4YACAA", "clause": {"children": [["medical-records", "Medical Records"], ["eligible-doctors", "Eligible Doctors"], ["", ""], ["practice-facilitation", "Practice Facilitation"], ["evaluation-activities-and-interim-findings", "Evaluation Activities and Interim Findings"]], "title": "Reenrollment", "parents": [["member-eligibility-and-enrollment", "MEMBER ELIGIBILITY AND ENROLLMENT"], ["notice-to-student-enrollees", "Notice to Student Enrollees"], ["health-insurance", "HEALTH INSURANCE"], ["health-insurance-opt-out", "Health Insurance Opt-out"], ["non-emergency-transportation", "Non-emergency Transportation"]], "size": 58, "id": "reenrollment", "related": [["enrollment", "Enrollment", "Enrollment"], ["disenrollment", "Disenrollment", "Disenrollment"], ["special-enrollment", "Special Enrollment", "Special Enrollment"], ["enrollment-period", "Enrollment Period", "Enrollment Period"], ["open-enrollment", "Open Enrollment", "Open Enrollment"]], "related_snippets": [], "updated": "2025-07-12T05:45:48+00:00", "also_ask": [], "drafting_tip": null, "explanation": "The Reenrollment clause outlines the conditions and procedures under which a party, typically a student or participant, may rejoin a program or service after a period of absence or withdrawal. This clause may specify eligibility requirements, deadlines, and any associated fees or documentation needed for reenrollment. Its core practical function is to provide a clear and consistent process for returning participants, ensuring both parties understand the steps and obligations involved in resuming participation."}, "json": true, "cursor": ""}}