Common use of Enrollee Cost-Sharing Clause in Contracts

Enrollee Cost-Sharing. 7.11.1 The Contractor shall ensure that Network Providers collect Enrollee cost-sharing only as specified in Attachment 8 to this Contract. 7.11.2 The Contractor shall ensure that it accurately differentiates the categories of MiSalud Enrollees in its Marketing Materials and communications, to clarify the cost-sharing rules that are applied to each group. The Contractor shall ensure that the Enrollee’s eligibility category appears on the Enrollee ID Card, so that cost-sharing is correctly determined. 7.11.3 The Contractor shall ensure that, in keeping with the Co-Payment policies included in Attachment 8, Medicaid and CHIP Eligible Persons bear no cost-sharing responsibility under MiSalud for services provided within the Contractor’s PPN or for the treatment of an Emergency Medical Condition. 7.11.4 As provided in Attachment 8 to this Contract, the Contractor shall impose Co-Payments for services provided in an emergency room outside the Enrollee’s PPN, but only in limited circumstances. 7.11.4.1 For Medicaid and CHIP Eligible Persons, the Contractor shall not impose any Co-Payment for the treatment of an Emergency Medical Condition. The Contractor shall, however, as provided in Attachment 8 to this Contract, impose Co-Payments for services provided in an emergency room to treat a condition that does not meet the definition of Emergency Medical Condition as set forth in this Contract. 7.11.4.2 No Co-Payments shall be charged for CHIP children under eighteen years of age under any circumstances; and

Enrollee Cost-Sharing. 7.11.1 The Contractor shall ensure that Network Providers collect Enrollee the Enrollee’s cost-sharing portion only as specified in Attachment 8 to this Contract, as developed in accordance with 42 CFR 438.108. 7.11.2 The Contractor shall ensure that it accurately differentiates the categories of MiSalud GHP Enrollees in its Marketing Materials and communications, to clarify the cost-sharing rules that are applied to each group. The Contractor shall ensure that the Enrollee’s eligibility category appears on the Enrollee ID Card, so that cost-sharing is correctly determined. 7.11.3 The Contractor shall ensure that, in keeping with the Co-Payment policies included in Attachment 88 to this Contract, Medicaid and CHIP Eligible Persons Eligibles bear no cost-sharing responsibility under MiSalud the GHP for services provided within the Contractor’s PPN or for the treatment of an Emergency Medical ConditionPPN. 7.11.4 As provided in Attachment 8 to this Contract, the Contractor shall impose Co-Payments for services provided in an emergency room outside the Enrollee’s PPN, but only in limited circumstances. 7.11.4.1 For Medicaid and CHIP Eligible PersonsEligibles, the Contractor shall not impose any Co-Payment for the treatment of an Emergency Medical ConditionCondition or a Psychiatric Emergency. The Contractor shall, however, as provided in Attachment 8 to this Contract, impose Co-Payments for services provided in an emergency room to treat a condition that the attending physician determines, at the time of the visit, does not meet the definition of a Psychiatric Emergency or an Emergency Medical Condition as set forth in this Contract. 7.11.4.2 No and if the Enrollee does not consult the GHP Service Line Medical Advice Line before visiting the emergency room, and provide his or her call identification number at the emergency room. If the Enrollee presents the call identification number, no Co-Payments Payment shall be charged for CHIP children under eighteen years of age under any circumstances; andimposed.

Enrollee Cost-Sharing. 7.11.1 The Contractor shall ensure that Network Providers collect Enrollee cost-sharing only as specified in Attachment 8 to this Contract. 7.11.2 The Contractor shall ensure that it accurately differentiates the categories of MiSalud MI Salud Enrollees in its Marketing Materials and communications, to clarify the cost-sharing rules that are applied to each group. The Contractor shall ensure that the Enrollee’s eligibility category appears on the Enrollee ID Card, so that cost-sharing is correctly determined. 7.11.3 The Contractor shall ensure that, in keeping with the Co-Payment policies included in Attachment 8, Medicaid and CHIP Eligible Persons bear no cost-sharing responsibility under MiSalud MI Salud for services provided within the Contractor’s PPN or for the treatment of an Emergency Medical Condition. 7.11.4 As provided in Attachment 8 to this Contract, the Contractor shall impose Co-Payments for services provided in an emergency room outside the Enrollee’s PPN, but only in limited circumstances. 7.11.4.1 For Medicaid and CHIP Eligible Persons, the Contractor shall not impose any Co-Payment for the treatment of an Emergency Medical Condition. The Contractor shall, however, as provided in Attachment 8 to this Contract, impose Co-Payments for services provided in an emergency room to treat a condition that does not meet the definition of Emergency Medical Condition as set forth in this Contract. 7.11.4.2 No Co-Payments shall be charged for CHIP children under eighteen years of age under any circumstances; and