Benefit Plan Designs Requiring Primary Care Provider Assignments Sample Clauses

Benefit Plan Designs Requiring Primary Care Provider Assignments. Regardless of benefit plan design, Contractor shall report to the Exchange the extent to which all new applicable Enrollees of the Exchange are assigned by Contractor to a Primary Care Provider, Health Center or a Patient-Centered Medical Home (PCMH) within sixty (60) days of enrollment. Contractor will encourage Plan Enrollees to make a primary care selection. In the event the Enrollee does not select a primary care provider (PCP) within the allotted timeframe, the Enrollee may be auto-assigned to a PCP and the assignment shall be communicated to the Plan Enrollee. PCP assignment will be consistent with an Enrollee’s stated gender, language, ethnic and cultural preferences, and will consider geographic accessibility and existing family member assignment or prior provider assignment. To the extent assignment of an enrollee to a provider would require changes in the Contractor’s provider agreements, Contractor shall provide the Exchange with a transition plan to amend such agreements.
Sample 1
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Benefit Plan Designs Requiring Primary Care Provider Assignments. Regardless of benefit plan design, Contractor shall demonstrate to the Exchange that all new applicable Enrollees of the Exchange are assigned by Contractor to a Primary Care Provider or a Patient- Centered Medical Home (PCMH) within forty – five (45) days of enrollment. Contractor will instruct Plan Enrollees to make a primary care selection. In the event the Enrollee does not select a primary care provider (PCP) within the allotted timeframe, the Enrollee may be auto-assigned to a PCP and the assignment. PCP assignment will be consistent with an Enrollee’s stated gender and language preferences, and will consider geographic accessibility and existing family member assignment.
Sample 1

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