Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment.
Enrollee Handbook. Insurer shall provide an Enrollee handbook based on the model Enrollee handbook provided by FHKC. Insurer shall customize such material to the extent permitted or required by FHKC. The handbook shall include the following elements:
Enrollee Handbook. The Contractor shall submit a copy of the Enrollee Handbook to the Division for approval thirty (30) calendar days prior to distribution. The Division will respond within thirty (30) calendar days of the date of the Division’s receipt of the request. The Contractor must update the Enrollee Handbook annually, addressing changes in policies through submission of a cover letter identifying sections that have changed and/or a red- lined handbook showing before and after language. The red-lined document may be submitted on paper or electronically. Such changes must be approved by the Division prior to dissemination to enrollees and shall be submitted to the Division at least thirty
Enrollee Handbook. Contractor shall submit an Enrollee Handbook to the Department for Prior Approval before the first enrollment, when revised, and upon the Department’s request. Contractor shall not be required to submit format changes for Prior Approval, provided there is no change in the information conveyed. Contractor shall mail an Enrollee Handbook to new Enrollees no later than five (5) Business Days following receipt of the Enrollee’s initial enrollment record on the 834 Audit File. At a minimum, the Enrollee Handbook must contain: 5.18.5.1 Contractor’s contact information.
Enrollee Handbook. The Contractor shall submit the handbook to the Department for prior approval initially and as revised. The Contractor shall not be required to submit for prior approval format changes, provided there is no change in the information conveyed.
Enrollee Handbook. The Contractor shall publish an Enrollee Handbook and make the handbook available to Enrollees upon enrollment, to be delivered to the Enrollee within five (5) Business Days of Contractor’s notification of Enrollee’s enrollment. With the exception of a new Enrollee assigned to the Contractor, the Contractor is in compliance with this requirement if the Enrollee’s handbook is:
Enrollee Handbook. Contractor shall submit an Enrollee handbook to the Department for Prior Approval before the first enrollment, when revised, and upon the Department’s request. Contractor shall not be required to submit format changes for Prior Approval, provided there is no change in the information conveyed. Contractor shall mail an Enrollee handbook to new Enrollees no later than five (5) Business Days following receipt of the Enrollee’s initial enrollment record on the 834 Audit File. Contractor must include terms defined by the Department as provided in42 CFR §438.10(c)(4)(i) and follow the requirements of 42 CFR §438.10(g). At a minimum, the Enrollee handbook must contain:
Enrollee Handbook. DVHA and AHS shall coordinate the development of the Global Commitment to Health Waiver enrollee handbook, which shall help enrollees and potential enrollees understand the requirements and benefits of the various programs available through the Global Commitment to Health Waiver. DVHA shall mail the enrollee handbook to all new enrollee households within 45 business days of determination of eligibility for the Global Commitment to Health Waiver. Enrollees may request and obtain an enrollee handbook at any time. The enrollee handbook must be specific to the Global Commitment to Health Waiver and be written in language that is clear and easily understood by an elementary-level reader. The enrollee handbook must include a comprehensive description of the Global Commitment to Health Waiver, including a description of covered benefits, how to access services in urgent and emergent situations, how to access services in other situations (including family planning services and providers not participating in the Vermont Medicaid program), complaint and grievance procedures, appeal procedures (for eligibility determinations or service denials), enrollee disenrollment rights, and advance directives. With respect to information on grievance, appeal and Fair Hearing procedures and timeframes, the Global Commitment to Health Waiver enrollee handbook must include the following information: • Right to a State of Vermont Fair Hearing, method for obtaining a hearing, timeframe for filing a request, and rules that govern representation at the hearing; • Right to file grievances and appeals; • Requirements and timeframes for filing a grievance or appeal; • Availability of assistance in the filing process; • Toll-free numbers that the enrollee can use to obtain assistance in filing a grievance or an appeal; • The fact that, when requested by the enrollee, benefits will continue if the enrollee files an appeal or a request for a State of Vermont Fair Hearing within the timeframes specified for filing; and that the enrollee may be required to pay the cost of any services furnished while the appeal is pending if the denial is upheld; • Any appeal rights that the State of Vermont makes available to providers to challenge the failure of DVHA to cover a service; • Information about Advance Directives and the service providers’ obligation to honor the terms of such directives; The following additional information must be included in the enrollee handbook: • Information on specialty r...
Enrollee Handbook. Department will provide Contractor with an Enrollee handbook template. Contractor shall complete and submit the template to the Department for Prior Approval before the first enrollment, when revised, and upon the Department’s request. Contractor shall mail an Enrollee handbook to new Enrollees no later than five (5) Business Days following receipt of the Enrollee’s initial enrollment record on the 834 Audit File, or, no later than five (5) Business Days prior to an Enrollee’s Effective Enrollment Date. Contractor must include terms defined by the Department as provided in 42 CFR §438.10(c)(4)(i) and follow the requirements of 42 CFR §438.10(g). At a minimum, the Enrollee handbook must contain:
Enrollee Handbook. Insurer must use the model Enrollee handbook, model Enrollee notices and any definition for managed care terminology FHKC develops. Insurer may customize such material to the extent permitted or required by FHKC. Customized model materials must be approved by FHKC prior to use.
