Enrollee Assignment Process Sample Clauses
The Enrollee Assignment Process clause defines the procedures and criteria for assigning individuals, referred to as enrollees, to specific programs, services, or providers. Typically, this clause outlines the steps for matching enrollees based on eligibility, preferences, or availability, and may include timelines, notification requirements, and dispute resolution mechanisms. Its core function is to ensure a transparent and orderly method for assigning enrollees, thereby minimizing confusion and disputes while promoting fairness and efficiency in the allocation process.
Enrollee Assignment Process. During the first Contract Year, FHKC shall auto-assign potential enrollees to available insurers on a one-to-one (1:1) basis, upon application approval. Beginning with the second Contract Year, FHKC may choose to:
a. Continue assigning potential enrollees to available plans on a one-to-one (1:1) basis; or
b. Modify the auto-assignment process to an assignment ratio other than one-to-one (1:1) to the benefit of higher performing Florida Healthy Kids insurers. FHKC may consider performance measure results, provision of obligations in compliance with this Contract, quality assessment and performance improvement execution or any other aspect or aspects, in whole or in part, of Insurer’s obligations under this Contract, subject to FHKC’s sole discretion. At initial enrollment, Enrollees are provided a free-look period in which the Enrollee has ninety
Enrollee Assignment Process. During the first Contract Year, FHKC shall auto-assign potential enrollees to available insurers on a one-to-one (1:1) basis, upon application approval. Beginning with the second Contract Year, FHKC may choose to:
a. Continue assigning potential enrollees to available plans on a one-to-one (1:1) basis; or
b. Modify the auto-assignment process to an assignment ratio other than one-to-one (1:1) to the benefit of higher performing Florida Healthy Kids insurers. FHKC may consider performance measure results, provision of obligations in compliance with this Contract, quality assessment and performance improvement execution or any other aspect or aspects, in whole or in part, of Insurer’s obligations under this Contract, subject to FHKC’s sole discretion. At initial enrollment, Enrollees are provided a free-look period in which the Enrollee has ninety (90) Calendar Days to enroll with another insurer without cause. Enrollees are provided a free- look period annually. Enrollees may only request a change in insurers outside of a free-look period as provided in this section. FHKC is responsible for notifying enrollees of their right to request an enrollment change outside of the free-look period, if such choice is available in their Region, as follows: