Electronic Enrollment and Disenrollment. To the extent that the Contract Holder has elected to electronically enroll eligible employees or retirees and their eligible dependents ("Eligible Party" or Eligible Parties") in the Plan(s) ("Enroll" or "Enrollment") and to "Disenrollment"), and Aetna has agreed to accept Enrollment and Disenrollment information from Contract Holder through a roster and electronically process such Enrollments and Disenrollments, Contract Holder must meet certain administrative and legal requirements set forth in this section of this Group Agreement. Aetna will electronically Enroll Eligible Parties who have elected Plan(s) coverage ("Electronic Enrollment") and electronically Disenroll Members from the Plan(s) ("Electronic Disenrollment"), provided Contract Holder meets the following requirements: • Uses Aetna enrollment and Disenrollment forms approved by CMS for Electronic Enrollments and Disenrollments ("Aetna Enrollment and Disenrollment Forms"). As permitted under Mandates and this Group Agreement, Contract Holder may permit Eligible Parties to electronically submit an election form to enroll in a Plan(s) ("Online Enrollment Form") to Contract Holder ("Online Election Process"). • Confirms that all Aetna Enrollment and Disenrollment Forms and Online Enrollment Forms contain all data required by CMS, prior to requesting that Aetna process any Electronic Enrollments or Disenrollments. • Maintains and provides access to all original Aetna Enrollment and Disenrollment Forms and Online Enrollment Forms completed by Eligible Parties and Members in accordance with the Records section of this Group Agreement and all Mandates. • Submits Electronic Enrollment and Disenrollments to Aetna timely and accurately in accordance with Mandates, Aetna policies and procedures, and this Group Agreement. • Submits to Aetna all data elements that are required by CMS and Aetna with respect to each Electronic Enrollment and Disenrollment, including, but not limited to, the following data elements: • Name • Permanent Address • Medicare Claim Number (HICN) • End Stage Renal Disease (ESRD) • Gender • Date of Birth • Plan Section • Provider Selection • Provider Selection(if applicable) • Group Number • Class Code • Plan ID • Effective Date Contract Xxxxxx agrees to be bound by all Mandates applicable relating to Electronic Enrollment and Disenrollment. If Aetna determines, in its sole discretion andjudgement, that the Electronic Enrollment or Disenrollment information provided by Contract Holde...
Electronic Enrollment and Disenrollment. To the extent that the Contract Holder has elected to electronically enroll eligible employees and/or retirees and their eligible dependents (“Eligible Party” or Eligible Parties”) in the Aetna Medicare OpenSM Plan (PFFS) (“Enroll” or “Enrollment”) and to electronically Disenroll Members from the Aetna Medicare OpenSM Plan (PFFS), and Aetna has agreed to accept Enrollment and Disenrollment information from Contract Holder through a roster and electronically process such Enrollments and Disenrollments, Contract Holder must meet certain administrative and legal requirements set forth in this section of this Group Agreement.
