Member Disenrollment Sample Clauses

Member Disenrollment. The PH-MCO may not request Disenrollment of a Member because of an adverse change in the Member’s health status, or because of the Member’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from his or her Special Needs. The PH-MCO may not reassign or remove Members involuntarily from Network Providers who are willing and able to serve the Member.
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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’s 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’s Health Plan.
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Member Disenrollment. In accordance with 42 CFR 438.3(d)(3), the Contractor may neither terminate enrollment nor encourage a member to disenroll because of his or her health care needs or a change in health care status. A member’s health care utilization patterns may not serve as the basis for disenrollment from the Contractor. The Contractor must notify the DFR, in the manner prescribed by the State, 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.
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Member Disenrollment. In accordance with 42 CFR 438.3(d)(3), the Contractor may neither terminate enrollment nor encourage a member to disenroll because of his or her health care needs or a change in health care status. A member’s health care utilization patterns may not serve as the basis for disenrollment from the Contractor. The Contractor must notify the DFR, in the manner prescribed by the State, within thirty (30)
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Member Disenrollment. The PH-MCO may not reassign or remove Members involuntarily from Network Providers who are willing and able to serve the Member.
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Member Disenrollment. A. CONTRACTOR Requests for Disenrollment Member disenrollment shall only be considered in rare circumstances. The CONTRACTOR may request that a particular member be disenrolled. Disenrollment requests shall be submitted in writing to HSD. The request and supporting documentation shall meet requirements specified by HSD. If the disenrollment request is granted the CONTRACTOR retains responsibility for the member's care until such time as the member is enrolled with a new CONTRACTOR. If a request for disenrollment is approved the member shall not be re-enrolled with the CONTRACTOR for a period of time to be determined by HSD. Conditions that may permit lock-out or disenrollment are:
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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’s 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’s Health Plan. Member Disenrollment Requests A Member may request Disenrollment from the CONTRACTOR’s 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’s 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’s 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’s 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’s health care needs. For cause Disenrollment requests must be initiated with the E...
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Member Disenrollment. Upon Group’s notification to Coventry, Coverage for a Member will terminate on the last day of the month of an Employee termination or loss of eligibility.
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Member Disenrollment 
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Related to Member Disenrollment

  • Enrollment The School shall maintain accurate and complete enrollment data and daily records of student attendance.

  • Eligible Employee For purposes of the SIMPLE 401(k) Plan provisions, any Employee who is entitled to make Elective Deferrals under the terms of the SIMPLE 401(k) Plan.

  • Plan Administrator Employees must elect a plan administrator during their initial enrollment in Advantage and may change their plan administrator election only during the annual open enrollment and when permitted under Section 5. Dependents must be enrolled through the same plan administrator as the employee.

  • Application for Employment Employee understands and agrees that, as a condition of this Agreement, Employee shall not be entitled to any employment with the Company, and Employee hereby waives any right, or alleged right, of employment or re-employment with the Company. Employee further agrees not to apply for employment with the Company and not otherwise pursue an independent contractor or vendor relationship with the Company.

  • Compensation Review The compensation of the Executive will be reviewed not less frequently than annually by the board of directors of the Company.

  • Election Form The Consideration shall be payable in accordance with the election made by Contributor in the Consideration Election Form (“Election Form”) accompanying the PPM, the results of which election are set forth on Exhibit A hereto. If, pursuant to the Election Form, Contributor (A) elected all or part of Contributor’s consideration payable hereunder to be in the form of units of limited partnership interests of the Operating Partnership (“OP Units”) and (B) submitted to the Operating Partnership (x) an executed Investor Questionnaire representing and warranting to the Operating Partnership that Contributor is an “accredited investor” as defined in the Investor Questionnaire and (y) any other documentation required by the Operating Partnership, including, but not limited to, a signature page to the Partnership Agreement (as hereinafter defined), Contributor shall receive OP Units in an amount determined in the manner described on Exhibit A hereto. The portion of the Consideration, if any, payable in cash is set forth on Exhibit A. Contributor agrees that the cash payment shall be made and the OP Units shall be registered in the name of the persons or entities set forth on the Election Form. OP Units will only be delivered to Contributor if Contributor has represented to the Operating Partnership that Contributor is an “accredited investor”. No fractional OP Units will be issued and OP Units will be rounded to the nearest whole number. The Consideration payable to Contributor, whether in cash, in OP Units or a combination thereof, may be reduced by the amount the Operating Partnership reasonably determines must be withheld for tax purposes. The rights and obligations of holders of OP Units as of the Closing will be as set forth in the First Amended and Restated Agreement of Limited Partnership of the Operating Partnership (the “Partnership Agreement”), a draft copy of which is included as an exhibit to the PPM.

  • Death After Separation from Service But Before Benefit Distributions Commence If the Executive is entitled to benefit distributions under this Agreement, but dies prior to the commencement of said benefit distributions, the Bank shall distribute to the Beneficiary the same benefits that the Executive was entitled to prior to death except that the benefit distributions shall commence within thirty (30) days following receipt by the Bank of the Executive’s death certificate.

  • Deferral Election A Participant may elect to defer all or a specified percentage of the Compensation earned in a Plan Year by such Participant for serving as a member of the Board of any Participating Fund or as a member of any committee or subcommittee thereof. Reimbursement of expenses of attending meetings of the Board, committees of the Board or subcommittees of such committees may not be deferred. Such election shall be made by executing before the first day of such Plan Year such election notice as the Administrator may prescribe; provided, however, that upon first becoming eligible to participate in the Plan by reason of appointment to a Board, a Participant may file a Deferral Election not later than 30 days after the effective date of such appointment, which election shall apply to Compensation earned in the portion of the Plan Year commencing the day after such election is filed and ending on the last day of such Plan Year.

  • Root Cause Analysis Upon Vendor's failure to provide the Services in accordance with the applicable Service Levels (for any reason other than a Force Majeure Event) Vendor will promptly (a) perform a root-cause analysis to identify the cause of such failure, (b) provide Prudential with a report detailing the cause of, and procedure for correcting, such failure, (c) obtain Prudential's written approval of the proposed procedure for correcting such failure, (d) correct such failure in accordance with the approved procedure, (e) provide weekly (or more frequent, if appropriate) reports on the status of the correction efforts, and (f) provide Prudential with assurances satisfactory to Prudential that such failure has been corrected and will not recur.

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