New Enrollee definition

New Enrollee means an employee who was not enrolled in the plan as of the implementation date referenced at Section B.
New Enrollee. An Eligible Person who has become a first-time Enrollee of the GHP. Occupation Level: A measure of how much time Call Center Choice Counselors spend on live calls and/or completing work related to those calls. Open Enrollment: A period of ninety (90) Calendar Days during which Enrollees have one (1) opportunity to select a different MCO or PCP, without cause, as set forth in Section 5.3 of this Contract. Personal Health Information (“PHI”): Per 42 CFR Part 160 and 42 CFR Part 164, individually identifiable health Information that is transmitted by electronic media, maintained in electronic media, or transmitted or maintained in any other form or medium. Potential Enrollee: A person who has been certified by the Puerto Rico Medicaid Program as eligible to enroll in the GHP (whether on the basis of Medicaid eligibility, CHIP eligibility, or eligibility as a member of the State Population), but who has not yet enrolled with the GHP Program or with an MCO.
New Enrollee. An Eligible Person who became a Potential Enrollee after November 1, 2018. Non-Emergency Medical Transportation (“NEMT”): A ride, or reimbursement for a ride, provided so that an Enrollee with no other transportation resources can receive Covered Services from a Provider. NEMT does not include transportation provided on an emergency basis, such as trips to the emergency room in life threatening situations. Notice of Adverse Benefit Determination: The written notice described in Section 14.4.3 of the ASES Contract, in which the Contractor notifies both the Enrollee and the Provider of an Adverse Benefit Determination.

Examples of New Enrollee in a sentence

  • New Enrollee Information‌ The Contractor shall provide New Enrollees with Enrollee Information that meets the requirements of Section 2.8.C including a Provider directory that meets the requirements of Section 2.5.C and an Enrollee handbook based on a model provided by EOHHS, as further directed by EOHHS, that contains the Enrollee Information specified below.

  • New Enrollee materials are not required for a former Enrollee who was disenrolled because of the loss of Medicaid eligibility and who regains his/her eligibility within sixty (60) days and is automatically reinstated as a Health Plan Enrollee.

  • New Enrollee Information‌ The Contractor shall provide New Enrollees with Enrollee Information that meets the requirements of Section 2.9.C including a Provider directory that meets the requirements of Section 2.6.D and an Enrollee handbook based on a model provided by EOHHS, as further directed by ▇▇▇▇▇, that contains the Enrollee Information specified below.

  • New Enrollee – any Enrollee enrolled by EOHHS pursuant to Section 2.5 who has not been previously enrolled in the Contractor within the preceding 12 months, or within another timeframe as determined by EOHHS.

  • New Enrollee – any Enrollee enrolled by EOHHS pursuant to Section 2.4 who has not been previously enrolled in the Contractor’s Plan within the preceding 12 months, or within another timeframe as determined by EOHHS.

  • New Enrollee materials are not required for a former Enrollee who was disenrolled because of the loss of Medicaid eligibility and who regains his/her eligibility within 180 days and is automatically reinstated as a Health Plan Enrollee.

  • If the New Enrollee does not select a MCO, the Puerto Rico Medicaid Program will select a MCO on behalf of the New Enrollee.

  • The Average Life Cost shall mean the average unreimbursed cost per fiscal year to CPMC for providing services to each New Enrollee over the previous two (2) fiscal years.

  • For the purposes of this subsection, New Enrollee shall be defined as an Enrollee that applies for enrollment after the Effective Date of this Sanction (the date determined in accordance with 42 CFR 438.730(f)).

  • The New Enrollee Shortfall shall be the difference between the number of New Enrollees that CPMC was required to accept under the New Medi-Cal Beneficiaries Commitment for that fiscal year and the number of New Enrollees that CPMC did accept in that fiscal year.


More Definitions of New Enrollee

New Enrollee. An Eligible Person who became a Potential Enrollee after January 1, 2023. Non-Emergency Medical Transportation (“NEMT”): A ride, or reimbursement for a ride, provided so that an Enrollee with no other transportation resources can receive Covered Services from a Provider. NEMT does not include transportation provided on an emergency basis, such as trips to the emergency room in life threatening situations.
New Enrollee. An Eligible Person who became a Potential Enrollee after November 1, 2018.

Related to New Enrollee

  • Enrollee means any person entitled to health care services from a carrier.

  • Newborn means a baby less than nine days old.

  • Health plan or "health benefit plan" means any policy,

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).