Common use of Disenrollment Requests For Cause Clause in Contracts

Disenrollment Requests For Cause. A Member may request Disenrollment from the CONTRACTOR’s health plan for cause at any time. 3.12.1.4.1. The following are considered acceptable for-cause Disenrollments: 3.12.1.4.1.1. Change in Member Residence The Member moves out of the CONTRACTOR’s Service Area, 3.12.1.4.1.2. Contract Termination The CONTRACTOR or the Department has terminated the contract, 3.12.1.4.1.3. The member is in need of related services (for example, a Cesarean Section and a tubal ligation) to be performed at the same time; not all related services are available within the Provider network; and the Enrollee's primary care Provider or another Provider determines that receiving the services separately would subject the Enrollee to unnecessary risk. 3.12.1.4.1.4. For members that use Managed Long Term Care Support Services (MLTSS), the Enrollee would have to change their residential, institutional, or employment supports Provider based on that Provider's change in status from an in-network to an out-of-network Provider with the CONTRACTOR. 3.12.1.4.1.5. Members may Disenroll without cause if the Plan does not, because of moral or religious objections, cover the service the Enrollee seeks.

Disenrollment Requests For Cause. A Member may request Disenrollment from the CONTRACTOR’s health plan for cause at any time. 3.12.1.4.13.11.1.4.1. The following are considered acceptable for-cause Disenrollments: 3.12.1.4.1.13.11.1.4.1.1. Change in Member Residence The Member moves out of the CONTRACTOR’s Service Area, 3.12.1.4.1.23.11.1.4.1.2. Contract Termination The CONTRACTOR or the Department has terminated the contract, 3.12.1.4.1.33.11.1.4.1.3. The member is in need of related services (for example, a Cesarean Section and a tubal ligation) to be performed at the same time; not all related services are available within the Provider network; and the Enrollee's primary care Provider or another Provider determines that receiving the services separately would subject the Enrollee to unnecessary risk. 3.12.1.4.1.43.11.1.4.1.4. For members that use Managed Long Term Care Support Services (MLTSS), the Enrollee would have to change their residential, institutional, or employment supports Provider based on that Provider's change in status from an in-network to an out-of-network Provider with the CONTRACTOR. 3.12.1.4.1.53.11.1.4.1.5. Members may Disenroll without cause if the Plan does not, because of moral or religious objections, cover the service the Enrollee seeks.