Common use of Annual Notification Clause in Contracts

Annual Notification. Once a year, Contractor must notify members in writing of their rights to request and obtain the information listed below: • Names, locations, telephone numbers of, and non-English languages spoken by current contracted providers in the member’s services area, including those not accepting new patients. • Any restriction on the member’s freedom of choice of network providers • Member rights and protections, including those specified in 42 C.F.R. § 438.100 • Notify all members of their disenrollment rights • Information on grievance, appeal, and State Fair Hearing procedures, including applicable time frames and the information specified in 42 C.F.R. § 438.10(g)(1) • The amount, duration, and scope of benefits available under this Agreement in sufficient detail to ensure that members understand the benefits to which they are entitled • Procedures for obtaining benefits, including authorization requirements • The extent to which, and how, members may obtain benefits from out- of-network providers • The extent to which, and how, after-hours and emergency coverage are provided, including: ⮚ The fact that prior authorization is not required for emergency services. ⮚ The process and procedures for obtaining emergency services, including use of the 911-telephone system or its local equivalent. ⮚ The member has a right to use any hospital or other setting for emergency care. • Cost-sharing, if applicable • Additional information that is available on request, including information on the structure and operation of the Dental Plan and provider incentive plans as set forth in 42 C.F.R. § 438.6(h). Contractor agrees to submit to EOHHS for prior review and approval the written materials to be used to fulfill these requirements in accordance with Guidelines for Marketing and Member Communication Materials for Rhode Island’s Medicaid Managed Care Programs.

Annual Notification. Once a year, Contractor must notify members in writing of their rights to request and obtain the information listed below: • Names, locations, telephone numbers of, and non-English languages spoken by current contracted providers in the member’s services area, including those not accepting new patients. • Any restriction on the member’s freedom of choice of network providers • Member rights and protections, including those specified in 42 C.F.R. § 438.100 • Notify all members of their disenrollment rights • Information on grievance, appeal, and State Fair Hearing procedures, including applicable time frames and the information specified in 42 C.F.R. § 438.10(g)(1) • The amount, duration, and scope of benefits available under this Agreement in sufficient detail to ensure that members understand the benefits to which they are entitled • Procedures for obtaining benefits, including authorization requirements • The extent to which, and how, members may obtain benefits from out- of-network providers • The extent to which, and how, after-hours and emergency coverage are provided, including: ⮚  The fact that prior authorization is not required for emergency services. ⮚  The process and procedures for obtaining emergency services, including use of the 911-telephone system or its local equivalent. ⮚  The member has a right to use any hospital or other setting for emergency care. • Cost-sharing, if applicable • Additional information that is available on request, including information on the structure and operation of the Dental Plan and provider incentive plans as set forth in 42 C.F.R. § 438.6(h). Contractor agrees to submit to EOHHS for prior review and approval the written materials to be used to fulfill these requirements in accordance with Guidelines for Marketing and Member Communication Materials for Rhode Island’s Medicaid Managed Care Programs.

Annual Notification. Once a year, Contractor must notify members in writing of their rights to request and obtain the information listed below: • Names, locations, telephone numbers of, and non-English languages spoken by current contracted providers in the member’s services area, including those not accepting new patients. • Any restriction on the member’s freedom of choice of network providers • Member rights and protections, including those specified in 42 C.F.R. § 438.100 • Notify all members of their disenrollment rights • Information on grievance, appeal, and State Fair Hearing procedures, including applicable time frames and the information specified in 42 C.F.R. § 438.10(g)(1) • The amount, duration, and scope of benefits available under this Agreement in sufficient detail to ensure that members understand the benefits to which they are entitled • Procedures for obtaining benefits, including authorization requirements • The extent to which, and how, members may obtain benefits from out- out-of-network providers • The extent to which, and how, after-hours and emergency coverage are provided, including: ⮚ The fact that prior authorization is not required for emergency services. ⮚ The process and procedures for obtaining emergency services, including use of the 911-telephone system or its local equivalent. ⮚ The member has a right to use any hospital or other setting for emergency care. • Cost-sharing, if applicable • Additional information that is available on request, including information on the structure and operation of the Dental Plan and provider incentive plans as set forth in 42 C.F.R. § 438.6(h). Contractor agrees to submit to EOHHS for prior review and approval the written materials to be used to fulfill these requirements in accordance with Guidelines for Marketing and Member Communication Materials for Rhode Island’s Medicaid Managed Care Programs.