Disenrollment Management Sample Clauses

Disenrollment Management. USPG shall administer the PDP’s disenrollment process in accordance with policies and procedures jointly developed by the parties and in accordance with CMS disenrollment procedure requirements. 1. USPG will accept and process *** from *** as specified by CMS. USPG will: (i) Submit a *** within ***; (ii) Provide the *** with a *** as CMS determines and approves; and (iii) File and retain *** for the period specified in ***. (i) USPG shall initiate and process *** in accordance with applicable ***. Except as ***, USPG shall not***, or by any *** or *** or ***. (ii) USPG shall *** in any of the following circumstances: (a) Any ***, as specified under paragraph (d)(1) of this section; or (b) The ***, as specified under paragraph (d)(2) of this section. (iii) USPG shall *** in any of the following circumstances: (a) The ***; (b) The ***; (c) ***; (d) *** or by *** or through ***; and (e) The individual ***, as determined by ***, to the *** or USPG that the individual has or expects to ***. USPG shall *** accordance with the procedures for *** set forth at ***. (iv) USPG shall prepare a *** to ensure *** from *** for *** enrollees. CONFIDENTIAL MATERIALS OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION. ASTERISKS DENOTE SUCH OMISSION. (i) If the *** is for any of the reasons specified in Sections B, C(i) or (iv) of this section (that is, other than *** USPG shall give the individual *** with an *** pursuant to *** and any ***. (ii) for *** in Sections B, C(i) and (iii) shall: • Be provided to the individual before *** of the ***; and • Include an *** of the *** under the PDP’s ***. 4. USPG will notify *** in the event of a *** of the *** and *** for *** under Part D in accordance with Part ***. Post-Enrollment Service: Enrollee *** USPG shall perform the following *** on behalf of CIGNA for Enrollees in accordance with CMS requirements set forth at *** and any CMS guidance, when issued. 1. By the ***, USPG shall *** under the PDP. USPG shall *** for that *** according to USPG’s enrollment records. 2. USPG shall permit each Enrollee, at the Enrollee’s option, to *** or other ***. 3. USPG shall be able to allow Enrollees to *** and ***. USPG shall not *** or the *** for such ***. 4. USPG shall be able to support *** to and *** from ***. 5. USPG shall instruct Enrollees to ***, whether by *** or, if ***, ***. All *** by USPG on behalf of CIGNA shall be *** by CIGNA within *** by USPG. 6. USPG shall update its enrollee records of all ***. 7....
Sample 1
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Disenrollment Management. USPG shall administer the PDP’s disenrollment process in accordance with policies and procedures jointly developed by the parties and in accordance with CMS disenrollment procedure requirements. 1. [***]. USPG will [***] and [***] from [***]. [***]: (i) Submit a [***] to [***] within [***]; (ii) Provide the [***] with a [***] of [***] as [***] and [***]; and (iii) File and retain [***] for the period specified in [***]. 2. [***]. (i) USPG shall [***] and [***] [***] of [***] in accordance with applicable CMS requirements. Except as permitted by CMS regulations, USPG shall not [***] [***] the [***], or [***] or [***], or [***] or [***], [***] or [***] to [***]. (ii) [***]. USPG shall [***] an [***] the [***] in any of the following circumstances: (a) Any [***] is not [***] on a [***], as specified under paragraph [***]; or (b) The [***] has [***] in [***], as specified under paragraph [***]. (iii) [***]. USPG shall [***] an [***] from the [***] in any of the following circumstances: (a) The [***] in the [***]; (b) The [***] for [***]; (c) [***] of [***]; (d) [***] is terminated by [***] or [***] [***] or [***] [***]; and (e) The [***], as determined by [***], to the [***] or [***] that the individual has or expects to [***] for [***]. USPG shall [***] in [***] with the [***] for [***] at [***]. (iv) [***] USPG shall prepare a [***] of [***] to [***] of [***] from [***] for [***] 3. [***]. (i) If the [***] is for any of the reasons specified in Sections B, C(i) or (iv) of this section (that is, other than [***] or [***] USPG shall give the [***] of the [***] with [***] of [***] to [***] the [***] and [***]. (ii) [***] for reasons specified in Sections B, C(i) and (iii) shall: • Be provided to the individual before submission of the disenrollment notice to CMS; and • Include an explanation of [***] to [***].
Sample 1
Disenrollment Management. USPG shall administer the PDP and PFFS products’ disenrollment processes in accordance with policies and procedures jointly developed by the parties and in accordance with CMS disenrollment procedure requirements. 1. [***]. USPG will [***] from [***]: (i) [***] in the [***] the submission to [***] of a [***] within [***]. USPG shall perform the following [***] and [***] on behalf of CIGNA for Enrollees in accordance with CMS requirements set forth at [***] or [***], as applicable, and any CMS guidance, when issued.
Sample 1
Disenrollment Management. USPG shall administer the PDP’s disenrollment process in accordance with policies and procedures jointly developed by the parties and in accordance with CMS disenrollment procedure requirements.
Sample 1

Related to Disenrollment Management

  • Disenrollment An Enrollee must be disenrolled from the Plan if the Beneficiary: a. No longer resides in the State of Mississippi; b. Is deceased; c. No longer qualifies for medical assistance under one of the Medicaid eligibility categories in the targeted population. The Contractor must notify the Division within three (3) days of their request that an Enrollee is disenrolled for a reason listed above and provide written documentation of disenrollment. Disenrollment shall be effective on the first day of the calendar month for which the disenrollment appears on the Enrollee Listing Report. The Contractor shall not disenroll an Enrollee because of an adverse change in the Enrollee’s health status, or because of the Enrollee’s utilization of medical services, diminished mental capacity, or uncooperative or disruptive behavior resulting from Enrollee’s special needs (except when Enrollee’s continued enrollment in the CCO seriously impairs the Contractor’s ability to furnish services to either this particular Enrollee or other Enrollees.) The Contractor must file a request to disenroll an Enrollee with the Division in writing stating specifically the reasons for the request if the reasons are for other than those specified above. An Enrollee may request disenrollment without cause during the ninety (90) days following the date the Division sends the Enrollee notice of enrollment or the date of the Enrollee’s initial enrollment, whichever is later, during the annual open enrollment period, upon automatic reenrollment if the temporary loss of Medicaid eligibility has caused the Enrollee to miss the annual disenrollment opportunity, or when the Division imposes an intermediate sanction on the Contractor as specified in this Contract. An Enrollee may request disenrollment from the CCO for cause if the CCO does not, because of moral or religious objections, cover the service the Enrollee seeks, the Enrollee needs related services to be performed at the same time, not all related services are available within the network, the Enrollee’s primary care provider or another provider determines receiving the services separately would subject Enrollee to unnecessary risk, poor quality of care, lack of access to services covered under the Plan, or lack of access to providers experienced in dealing with the Enrollee’s health care needs. Enrollee requests for disenrollment must be directed to the Division either orally or in writing. The effective date of any approved disenrollment will be no later than the first day of the second month following the month in which the Enrollee or the Plan files the request with the Division.

  • Enrollment The Competitive Supplier shall be responsible for enrolling all Eligible Consumers through EDI transactions submitted to the LDC for all enrollments of Eligible Consumers during the term of this Agreement.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Stock Plan Administration Service Provider The Company transfers the Optionee's Personal Information to Fidelity Stock Plan Services LLC, an independent service provider based in the United States, which assists the Company with the implementation, administration and management of the Plan (the “Stock Plan Administrator”). In the future, the Company may select a different Stock Plan Administrator and share the Optionee's Personal Information with another company that serves in a similar manner. The Stock Plan Administrator will open an account for the Optionee to receive and trade Shares acquired under the Plan. The Optionee will be asked to agree on separate terms and data processing practices with the Stock Plan Administrator, which is a condition to the Optionee’s ability to participate in the Plan.

  • Virus Management DST shall maintain a malware protection program designed to deter malware infections, detect the presence of malware within DST environment.

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department will advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor will be bound by the changes in enrollment procedures.

  • Special Enrollment a. KFHPWA will allow special enrollment for persons: 1) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and have had such other coverage terminated due to one of the following events: • Cessation of employer contributions. • Exhaustion of COBRA continuation coverage. • Loss of eligibility, except for loss of eligibility for cause. 2) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and who have had such other coverage exhausted because such person reached a lifetime maximum limit. KFHPWA or the Group may require confirmation that when initially offered coverage such persons submitted a written statement declining because of other coverage. Application for coverage must be made within 31 days of the termination of previous coverage. b. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents (other than for nonpayment or fraud) in the event one of the following occurs: 1) Divorce or Legal Separation. Application for coverage must be made within 60 days of the divorce/separation. 2) Cessation of Dependent status (reaches maximum age). Application for coverage must be made within 30 days of the cessation of Dependent status. 3) Death of an employee under whose coverage they were a Dependent. Application for coverage must be made within 30 days of the death of an employee. 4) Termination or reduction in the number of hours worked. Application for coverage must be made within 30 days of the termination or reduction in number of hours worked. 5) Leaving the service area of a former plan. Application for coverage must be made within 30 days of leaving the service area of a former plan. 6) Discontinuation of a former plan. Application for coverage must be made within 30 days of the discontinuation of a former plan. c. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents in the event one of the following occurs: 1) Marriage. Application for coverage must be made within 31 days of the date of marriage. 2) Birth. Application for coverage for the Subscriber and Dependents other than the newborn child must be made within 60 days of the date of birth. 3) Adoption or placement for adoption. Application for coverage for the Subscriber and Dependents other than the adopted child must be made within 60 days of the adoption or placement for adoption. 4) Eligibility for premium assistance from Medicaid or a state Children’s Health Insurance Program (CHIP), provided such person is otherwise eligible for coverage under this EOC. The request for special enrollment must be made within 60 days of eligibility for such premium assistance. 5) Coverage under a Medicaid or CHIP plan is terminated as a result of loss of eligibility for such coverage. Application for coverage must be made within 60 days of the date of termination under Medicaid or CHIP. 6) Applicable federal or state law or regulation otherwise provides for special enrollment.

  • Disease Management If you have a chronic condition such as asthma, coronary heart disease, diabetes, congestive heart failure, and/or chronic obstructive pulmonary disease, we’re here to help. Our tools and information can help you manage your condition and improve your health. You may also be eligible to receive help through our care coordination program. This voluntary program is available at no additional cost you. To learn more about disease management, please call (000) 000-0000 or 0-000-000-0000. Our entire contract with you consists of this agreement and our contract with your employer. Your ID card will identify you as a member when you receive the healthcare services covered under this agreement. By presenting your ID card to receive covered healthcare services, you are agreeing to abide by the rules and obligations of this agreement. Your eligibility for benefits is determined under the provisions of this agreement. Your right to appeal and take action is described in Appeals in Section 5. This agreement describes the benefits, exclusions, conditions and limitations provided under your plan. It shall be construed under and shall be governed by the applicable laws and regulations of the State of Rhode Island and federal law as amended from time to time. It replaces any agreement previously issued to you. If this agreement changes, an amendment or new agreement will be provided.

  • Staffing Plan The Board and the Association agree that optimum class size is an important aspect of the effective educational program. The Polk County School Staffing Plan shall be constructed each year according to the procedures set forth in Board Policy and, upon adoption, shall become Board Policy.

  • Program Management 1.1.01 Implement and operate an Immunization Program as a Responsible Entity 1.1.02 Identify at least one individual to act as the program contact in the following areas: 1. Immunization Program Manager;

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