Common use of Disenrollment Notice Clause in Contracts

Disenrollment Notice. The Health Plan shall notify enrollees who will be involuntarily disenrolled due to the enrollee no longer being clinically eligible for enrollment in the Health Plan, of the following at least two months prior to the anticipated effective date of the involuntary disenrollment. The template for such notice must be submitted to and approved by BMHC prior to use. a. The reason for involuntary disenrollment; b. The telephone number of the choice counselor/enrollment broker; and c. Transition information. The below newborn enrollment process applies only to those newborns for whom the Health Plan followed the unborn activation process specified in Attachment II, Section III, Eligibility and Enrollment, Item B.3. Newborns not enrolled through the unborn activation process must be enrolled through the Agency’s choice counselor/enrollment broker. a. Once the Health Plan confirms activation of the baby’s Medicaid ID, the Health Plan shall submit to the Medicaid area office a request to enroll the newborn, as described below. Newborn enrollments are always effective the next available enrollment month. (1) To submit newborn enrollment requests, the Health Plan shall complete an ENR – Newborn Excel worksheet titled “***-WORKBOOK-Newborn-Enroll-YYMMDD.xls,” providing all the information required for the newborn’s enrollment into the Health Plan. The Excel workbook format and naming convention is provided in the Agency’s Report Guide. The Health Plan shall submit the completed workbook to the local Medicaid area office for newborn enrollment processing. (2) Newborn requests shall be submitted electronically to the local Medicaid area office each Wednesday using the Excel workbook template provided by the Agency. All fields shall be completed in full. Before sending the workbook by e-mail, the Health Plan shall password-protect the Excel file. The password shall be sent to the area office in a separate e-mail message. (3) Only new newborn enrollment requests are to be submitted each week. If there are no new cases for a particular week, the Health Plan shall so indicate in an e-mail to the Agency area office. b. The Medicaid area office will enroll the newborn in the Health Plan for the next available enrollment month after checking to ensure that the family has not contacted the Agency or its agent to enroll the newborn in another health plan. If the family already has made an enrollment choice, the area office will not enroll the newborn in the Health Plan by the newborn enrollment process. When enrollment occurs by the unborn/newborn activation method, the family may change health plans for the newborn through the Agency or its agent at any time.