New Enrollee definition

New Enrollee means an employee who was not enrolled in the plan as of the implementation date referenced at Section B.
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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.
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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.
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Examples of New Enrollee in a sentence

  • Once the Care Management Team is informed that an individual is enrolled in the Plan, staff reaches out to the enrollee through written materials, telephonically and face to face, to welcome them to the Plan, and gather the HRA as well as documenting our New Enrollee interview.

  • 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.

  • If the defined New Enrollee Capitation is greater than 50% of the Total Population Capitation, the defined New Enrollees capitation and expenses may be deferred to the next MLR period.

  • Add the New Enrollee expenses deferred from the prior MLR reporting year as defined on page 28 of this guide.

  • Add the New Enrollee capitation deferred from the prior MLR reporting year as defined on page 28 of this guide.

  • 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.

  • 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.

  • Subtract the New Enrollee capitation and expense impact for the current MLR reporting year as defined on page 28 of this guide.

  • Options – Please select from the New Enrollment section OR the Transfer section based on your enrollment status.NEW ENROLLMENT – Circle one of the following: New Hire, New Enrollee or TRANSFER from another SHBP covered Agency or School Returning Member with break in coverage who missed an Open Enrollment.

  • 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.


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.
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New Enrollee. An Eligible Person who became a Potential Enrollee after November 1, 2018.
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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 creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • 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).

  • CMS means the Centers for Medicare and Medicaid Services.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • New employee orientation means the onboarding process of a newly hired classified employee, whether in person, online, or through other means or mediums, in which employees are advised of their employment status, rights, benefits, duties and responsibilities, or any other employment-related matters.

  • HMO means health maintenance organization.

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Medical cannabis card means the same as that term is defined in Section 26-61a-102.

  • MCP means a Material Change Proposal for the Station issued on [

  • Child Caregiver means an individual providing basic childcare service needs for Your minor children under the age of 18 while You are on the Trip without the minor children. The arrangement of being the Child Caregiver while You are on the Trip must be made 30 or more days prior to the Scheduled Departure Date.

  • MCO means an organization having a certificate of authority or certificate of registration from the 11 Washington State Office of Insurance Commissioner that contracts with HCA under a comprehensive 12 risk contract to provide prepaid health care services to eligible HCA Enrollees under HCA managed 13 care programs.

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79

  • Pharmacy benefits management means the administration or management of prescription drug

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • graduate psychiatric nurse means a person whose name is entered on the register of graduate psychiatric nurses of the College of Registered Psychiatric Nurses of Manitoba. The terms of this Agreement shall be applicable to the graduate nurse, the graduate practical nurse, graduate psychiatric nurse, and graduate nurse practitioner, except as otherwise specified in the Collective Agreement.

  • Family child care provider means a person who: (a) Provides

  • Late enrollee means an eligible employee or dependent who

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Approved abuse education training program means a training program using a curriculum approved by the abuse education review panel of the department of public health or a training program offered by a hospital, a professional organization for physicians, or the department of human services, the department of education, an area education agency, a school district, the Iowa law enforcement academy, an Iowa college or university, or a similar state agency.