Common use of Member Services Clause in Contracts

Member Services. 4.1 Marketing and Outreach Marketing efforts shall be targeted to the general community in the State of Indiana. In accordance with 42 CFR 438.104, and the requirements outlined in Section 4.5, the Contractor must obtain State approval for all marketing materials at least thirty (30) calendar days prior to distribution. All marketing materials must be distributed to the Contractor’s entire service area and shall comply with the information requirements delineated at 42 CFR 438.104 and should include the requirements and benefits of the Contractor’s health plans, as well as the Contractor’s provider network. Such materials shall be in a manner and format that is easily understood and meet the general communication material requirements discussed in this Section 4. Marketing materials should include the requirements and benefits of the Contractor’s health plan, as well as the Contractor’s provider network. The Contractor may market via digital, mail, and mass media advertising (e.g., radio, television and billboards). Community oriented marketing such as participation in community health fairs is encouraged. The Contractor may offer to potential members tokens or gifts of nominal value, as long as the Contractor acts in compliance with all marketing provisions provided for in 42 CFR 438.104, which addresses marketing activities, and other federal and state regulations and guidance regarding inducements in the Medicare and Medicaid programs. The Contractor shall conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor shall provide information to potential eligible individuals who live in medically underserved rural areas of the State. Any outreach and marketing activities (written and oral) shall be presented and conducted in an easily understood manner and format, at a fifth-grade reading level. The Contractor may not seek to influence enrollment in conjunction with the sale or offering of any private insurance and may not directly, or indirectly engage in door-to-door, telephone, email, texting, or other cold-call marketing activities. Cold-call marketing is defined at 42 CFR 438.104 and includes any unsolicited personal contact by the Contractor with a potential Medicaid member. The Contractor shall ensure marketing materials are accurate and do not mislead, confuse or defraud members or the State. Statements considered inaccurate, false, or misleading include, but are not limited to, any assertion or written or oral statement that: ▪ The member or potential member must enroll in the Contractor’s health plan to obtain benefits or to avoid losing benefits; ▪ The Contractor is endorsed by CMS, the federal or state government or a similar entity; or ▪ The Contractor’s health plan is the only opportunity to obtain benefits under the Hoosier Healthwise program. The Contractor cannot entice a potential member to join its health plan by offering any other type of insurance as a bonus for enrollment, and the Contractor shall ensure that a potential member can make his/her own decision as to whether or not to enroll. Marketing materials and plans shall be designed to reach a distribution of potential members across age and gender categories. The Contractor must conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor must provide information to potentially eligible individuals who live in medically underserved rural areas of the State. Potential members may not be discriminated against on the basis of health status or need for health care services, or on any other basis inconsistent with state or federal law, including Section 1557 of the Affordable Care Act / 45 CFR 92.1. The Contractor may distribute or mail an informational brochure or flyer to potential members and/or provide (at its own cost, including any costs related to mailing) such brochures or flyers to the State for distribution to individuals at the time of application. The Contractor shall submit product naming and associated domains to FSSA for review and approval to minimize confusion for members and providers.

Member Services. 4.1 Marketing and Outreach Marketing efforts shall be targeted to the general community in the State of Indiana. In accordance with 42 CFR 438.104, and the requirements outlined in Section 4.5, the Contractor must obtain State approval for all marketing materials at least thirty (30) calendar days prior to distribution. All marketing materials must be distributed to the Contractor’s entire service area and shall comply with the information requirements delineated at 42 CFR 438.104 438.10 and should include the requirements and benefits of the Contractor’s health plans, as well as the Contractor’s provider network. Such materials shall be in a manner and format that is easily understood and meet the general communication material requirements discussed in this Section 4. Marketing materials should include the requirements and benefits of the Contractor’s health plan, as well as the Contractor’s provider network. The Contractor may market via digital, mail, and mass media advertising (e.g., radio, television and billboards). Community oriented marketing such as participation in community health fairs is encouraged. The Contractor may offer to potential members tokens or gifts of nominal value, as long as the Contractor acts in compliance with all marketing provisions provided for in 42 CFR 438.104, which addresses marketing activities, and other federal and state regulations and guidance regarding inducements in the Medicare and Medicaid programs. The Contractor shall conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor shall provide information to potential eligible individuals who live in medically underserved rural areas of the State. Any outreach and marketing activities (written and oral) shall be presented and conducted in an easily understood manner and format, at a fifth-grade reading level. The Contractor may not seek to influence enrollment in conjunction with the sale or offering of any private insurance and may not directly, or indirectly engage in door-to-door, telephone, email, texting, or other cold-call marketing activities. Cold-call marketing is defined at 42 CFR 438.104 and includes any unsolicited personal contact by the Contractor with a potential Medicaid member. The Contractor shall ensure marketing materials are accurate and do not mislead, confuse or defraud members or the State. Statements considered inaccurate, false, or misleading include, but are not limited to, any assertion or written or oral statement that: ▪ The member or potential member must enroll in the Contractor’s health plan to obtain benefits or to avoid losing benefits; ▪ The Contractor is endorsed by CMS, the federal or state government or a similar entity; or ▪ The Contractor’s health plan is the only opportunity to obtain benefits under the Hoosier Healthwise program. The Contractor cannot entice a potential member to join its health plan by offering any other type of insurance as a bonus for enrollment, and the Contractor shall ensure that a potential member can make his/her own decision as to whether or not to enroll. Marketing materials and plans shall be designed to reach a distribution of potential members across age and gender categories. The Contractor must conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor must provide information to potentially eligible individuals who live in medically underserved rural areas of the State. Potential members may not be discriminated against on the basis of health status or need for health care services, or on any other basis inconsistent with state or federal law, including Section 1557 of the Affordable Care Act / 45 CFR 92.1. The Contractor may distribute or mail an informational brochure or flyer to potential members and/or provide (at its own cost, including any costs related to mailing) such brochures or flyers to the State for distribution to individuals at the time of application. The Contractor shall submit product naming and associated domains to FSSA for review and approval to minimize confusion for members and providers.

Member Services. 4.1 Marketing and Outreach Marketing efforts shall be targeted to the general community in the State of Indiana. In accordance with 42 CFR 438.104, and the requirements outlined in Section 4.5, the Contractor must obtain State approval for all marketing materials at least thirty (30) calendar days prior to distribution. All marketing materials must be distributed to the Contractor’s entire service area and shall comply with the information requirements delineated at 42 CFR 438.104 and should include the requirements and benefits of the Contractor’s health plans, as well as the Contractor’s provider network. Such materials shall be in a manner and format that is easily understood and meet the general communication material requirements discussed in this Section 4. Marketing materials should include the requirements and benefits of the Contractor’s health plan, as well as the Contractor’s provider network. The Contractor may market via digital, mail, and mass media advertising (e.g., radio, television and billboards). Community oriented marketing such as participation in community health fairs is encouraged. The Contractor may offer to potential members tokens or gifts of nominal value, as long as the Contractor acts in compliance with all marketing provisions provided for in 42 CFR 438.104, which addresses marketing activities, and other federal and state regulations and guidance regarding inducements in the Medicare and Medicaid programs. The Contractor shall conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor shall provide information to potential eligible individuals who live in medically underserved rural areas of the State. Any outreach and marketing activities (written and oral) shall be presented and conducted in an easily understood manner and format, at a fifth-grade reading level. The Contractor may not seek to influence enrollment in conjunction with the sale or offering of any private insurance and may not directly, or indirectly engage in door-to-door, telephone, email, texting, or other cold-call marketing activities. Cold-call marketing is defined at 42 CFR 438.104 and includes any unsolicited personal contact by the Contractor with a potential Medicaid member. The Contractor shall ensure marketing materials are accurate and do not mislead, confuse or defraud members or the State. Statements considered inaccurate, false, or misleading include, but are not limited to, any assertion or written or oral statement that: ▪ The member or potential member must enroll in the Contractor’s health plan to obtain benefits or to avoid losing benefits; ▪ The Contractor is endorsed by CMS, the federal or state government or a similar entity; or ▪ The Contractor’s health plan is the only opportunity to obtain benefits under the Hoosier Healthwise program. The Contractor cannot entice a potential member to join its health plan by offering any other type of insurance as a bonus for enrollment, and the Contractor shall ensure that a potential member can make his/her own decision as to whether or not to enroll. Marketing materials and plans shall be designed to reach a distribution of potential members across age and gender categories. The Contractor must conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor must provide information to potentially eligible individuals who live in medically underserved rural areas of the State. Potential members may not be discriminated against on the basis of health status or need for health care services, or on any other basis inconsistent inc onsistent with state or federal law, including Section 1557 of the Affordable Care Act / 45 CFR 92.1. The Contractor may distribute or mail an informational brochure or flyer to potential members and/or provide (at its own cost, including any costs related to mailing) such brochures or flyers to the State for distribution to individuals at the time of application. The Contractor shall submit product naming and associated domains to FSSA for review and approval to minimize confusion for members and providers.

Member Services. 4.1 Marketing and Outreach Marketing efforts shall be targeted to the general community in the State of Indiana. In accordance with 42 CFR 438.104, and the requirements outlined in Section 4.5, the Contractor must obtain State approval for all marketing materials at least thirty (30) calendar days prior to distribution. All marketing materials must be distributed to the Contractor’s entire service area and shall comply with the information requirements delineated at 42 CFR 438.104 438.10 and should include the requirements and benefits of the Contractor’s health plans, as well as the Contractor’s provider network. Such materials shall be in a manner and format that is easily understood and meet the general communication material requirements discussed in this Section 4. Marketing materials should include the requirements and benefits of the Contractor’s health plan, as well as the Contractor’s provider network. The Contractor may market via digital, mail, and mass media advertising (e.g., radio, television and billboards). Community oriented marketing such as participation in community health fairs is encouraged. The Contractor may offer to potential members tokens or gifts of nominal value, as long as the Contractor acts in compliance with all marketing provisions provided for in 42 CFR 438.104, which addresses marketing activities, and other federal and state regulations and guidance regarding inducements in the Medicare and Medicaid programs. The Contractor shall conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor shall provide information to potential eligible individuals who live in medically underserved rural areas of the State. Any outreach and marketing activities (written and oral) shall be presented and conducted in an easily understood manner and format, at a fifth-grade reading level. The Contractor may not seek to influence enrollment in conjunction with the sale or offering of any private insurance and may not directly, or indirectly engage in door-to-door, telephone, email, texting, or other cold-call marketing activities. Cold-call marketing is defined at 42 CFR 438.104 and includes any unsolicited personal contact by the Contractor with a potential Medicaid member. The Contractor shall ensure marketing materials are accurate and do not mislead, confuse or EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE defraud members or the State. Statements considered inaccurate, false, or misleading include, but are not limited to, any assertion or written or oral statement that: ▪ The member or potential member must enroll in the Contractor’s health plan to obtain benefits or to avoid losing benefits; ▪ The Contractor is endorsed by CMS, the federal or state government or a similar entity; or ▪ The Contractor’s health plan is the only opportunity to obtain benefits under the Hoosier Healthwise program. The Contractor cannot entice a potential member to join its health plan by offering any other type of insurance as a bonus for enrollment, and the Contractor shall ensure that a potential member can make his/her own decision as to whether or not to enroll. Marketing materials and plans shall be designed to reach a distribution of potential members across age and gender categories. The Contractor must conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor must provide information to potentially eligible individuals who live in medically underserved rural areas of the State. Potential members may not be discriminated against on the basis of health status or need for health care services, or on any other basis inconsistent with state or federal law, including Section 1557 of the Affordable Care Act / 45 CFR 92.1. The Contractor may distribute or mail an informational brochure or flyer to potential members and/or provide (at its own cost, including any costs related to mailing) such brochures or flyers to the State for distribution to individuals at the time of application. The Contractor shall submit product naming and associated domains to FSSA for review and approval to minimize confusion for members and providers.

Member Services. 4.1 Marketing and Outreach Marketing efforts shall be targeted to the general community in the State of Indiana. In accordance with 42 CFR 438.104, and the requirements outlined in Section 4.5, the Contractor must obtain State approval for all marketing materials at least thirty (30) calendar days prior to distribution. All marketing materials must be distributed to the Contractor’s entire service area and shall comply with the information requirements delineated at 42 CFR 438.104 and should include the requirements and benefits of the Contractor’s health plans, as well as the Contractor’s provider network. Such materials shall be in a manner and format that is easily understood and meet the general communication material requirements discussed in this Section 4. Marketing materials should include the requirements and benefits of the Contractor’s health plan, as well as the Contractor’s provider network. The Contractor may market via digital, mail, and mass media advertising (e.g., radio, television and billboards). Community oriented marketing such as participation in community health fairs is encouraged. The Contractor may offer to potential members tokens or gifts of nominal value, as long as the Contractor acts in compliance with all marketing provisions provided for in 42 CFR 438.104, which addresses marketing activities, and other federal and state regulations and guidance regarding inducements in the Medicare and Medicaid programs. The Contractor shall conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor shall provide information to potential eligible individuals who live in medically underserved rural areas of the State. Any outreach and marketing activities (written and oral) shall be presented and conducted in an easily understood manner and format, at a fifth-grade reading level. The Contractor may not seek to influence enrollment in conjunction with the sale or offering of any private insurance and may not directly, or indirectly engage in door-to-door, telephone, email, texting, or other cold-call marketing activities. Cold-call marketing is defined at 42 CFR 438.104 and includes any unsolicited personal contact by the Contractor with a potential Medicaid member. The Contractor shall ensure marketing materials are accurate and do not mislead, confuse or defraud members or the State. Statements considered inaccurate, false, or misleading include, but are not limited to, any assertion or written or oral statement that: ▪ The member or potential member must enroll in the Contractor’s health plan to obtain benefits or to avoid losing benefits; ▪ The Contractor is endorsed by CMS, the federal or state government or a similar entity; or ▪ The Contractor’s health plan is the only opportunity to obtain benefits under the Hoosier Healthwise program. The Contractor cannot entice a potential member to join its health plan by offering any other type of insurance as a bonus for enrollment, and the Contractor shall ensure that a potential member can make his/her own decision as to whether or not to enroll. Marketing materials and plans shall be designed to reach a distribution of potential members across age and gender categories. The Contractor must conduct marketing and advertising in a geographically balanced manner, paying special attention to rural areas of the State. The Contractor must provide information to potentially eligible individuals who live in medically underserved rural areas of the State. Potential members may not be discriminated against on the basis of health status or need for health care services, or on any other basis inconsistent with state or federal law, including Section 1557 of the Affordable Care Act / 45 CFR 92.1. The Contractor may distribute or mail an informational brochure or flyer to potential members and/or provide (at its own cost, including any costs related to mailing) such brochures or flyers to the State for distribution to individuals at the time of application. The Contractor shall submit product naming and associated domains to FSSA for review revi ew and approval to minimize confusion for members and providers.