Contractor Request. The Contractor must comply with Section 1.5.1: “Non-Discrimination” of this Contract and seek to disenroll a Dental Health Plan Enrollee only for good cause. The following actions, if found by OHCA, comprise good cause: • Dental Health Plan Enrollee has been enrolled in error, as determined by OHCA; • Dental Health Plan Enrollee has exhibited disruptive behaviors to the extent that the Contractor cannot effectively manage their care, and the Contractor has made all reasonable efforts to accommodate the Dental Health Plan Enrollee; or • Dental Health Plan Enrollee has committed Fraud, including but not limited to, loaning an ID card for use by another person. The Contractor must make a written request to OHCA for Dental Health Plan Enrollee Disenrollment, in a format to be specified by OHCA. The Contractor’s request for disenrollment must document that reasonable steps were taken to educate the Dental Health Plan Enrollee regarding proper behavior and that the Dental Health Plan Enrollee refused to comply, if applicable. The Contractor also must communicate its request to the Dental Health Plan Enrollee in writing, in a format to be specified by OHCA. OHCA shall have sole authority to grant or deny the Disenrollment request. Dental Health Plan Enrollee Request Dental Health Plan Enrollees shall be permitted to disenroll from the Contractor without cause, in accordance with the provisions of Section 1.5.4: “Enrollment Lock-In Period” of this Contract. During the lock-in period, Dental Health Plan Enrollees may be disenrolled for cause, at any time, in accordance with 42 C.F.R. § 438.56(d) and under the following conditions: • The Dental Health Plan Enrollee moves out of the Contractor’s service area; • Dental Health Plan Enrollee seeks covered benefits that the Contractor does not cover for moral or religious reasons; • Dental Health Plan Enrollee needs related services to be performed at the same time; not all related services are available within the Contractor’s network; and the Dental Health Plan Enrollee’s PCD Provider or another Provider determines that receiving the services separately would subject the Dental Health Plan Enrollee to unnecessary risk; • Dental Health Plan Enrollee has filed and prevailed in a Grievance regarding poor quality of care, lack of access to services covered under the Contract or lack of access to Providers experienced in dealing with the Dental Health Plan Enrollee's oral health care needs or other matters deemed sufficient...
Contractor Request. The Contractor must provide special requests for equipment needs, specific room layouts, and/or special software to LEISD no later than (10) days prior to the scheduled service date. A copy of the special software must be provided by the Contractor in advance and must be accompanied with a valid software license before installation. Information must be submitted on the enclosed Room Setup Form. AGREED and accepted on behalf of Contractor to be effective on the earliest date written above by a person authorized to bind Contractor. Contractor’s Signature: Date: LEISD Director/Principal Contact Info: Phone: Campus: Date: Assistant Superintendent of Finance & Operations/CFO or Designee Date: Contractor must sign two (2) originals: Retain one (1) and return one (1) original of this contract with attachments to: Business Services Little Elm ISD Box 6000 000 Xxxx Xxxx
Contractor Request. Without obligating City to give consent, Contractor will demonstrate to City’s satisfaction that the proposed transferee has the operational and financial ability to satisfy Performance Obligations. City is not obligated to consider any proposed Transfer by Contractor if Contractor is in breach at any time during City’s consideration.
Contractor Request. Without obligating KIB to give consent, Contactor will demonstrate to KIB’s satisfaction that the proposed transferee has the operational and financial ability to satisfy Performance Obligations. KIB is not obligated to consider any proposed Transfer by Contractor if Contractor is in Breach at any time during KIB’s consideration.
Contractor Request. Name of Contractor Phone Address (Street) (City) (Zip) Billing Address (If different from above address) Alternate Contact Person Phone Description of duties requested: Extra Duty Date(s): Day/Date Hours From To Number of officers requested: Please be advised that the police department may require additional officer, supervisors, and vehicles to ensure appropriate and safe conditions. You will be notified of any changes to your request before the resources are scheduled. I have read and understand this agreement. Contractor Signature Date VI. POLICE DEPARTMENT REVIEW (to be completed by police department staff)
