Common use of Enrollee Handbook Clause in Contracts

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customize. (C) The Contractor shall ensure that its Enrollee handbook contains the following information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharing, and how transportation is provided; (4) regarding cost sharing on any benefits provided by the Contractor; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled; (7) procedures for obtaining benefits, including Service Authorization requirements and/or referrals for specialty care; (8) on the extent to which, and how, after-hours care is provided; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions on the Enrollee’s freedom of choice among Network Providers; (17) on the extent to which, and how, Enrollees may obtain benefits from Non-Network Providers; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachment; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachment; (20) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (21) on the Enrollee’s right to: (i) file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (22) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (23) on the availability of assistance in the filing process for Grievances; (24) on the availability of assistance in requesting Appeals; (25) on the fact that, when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests an Appeal or a State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (26) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHC; (28) on how to exercise an Advance Directive; (29) on how to access auxiliary aids and services, including additional information in alternative formats or languages, at no cost; (30) regarding the toll-free telephone numbers for Member Services, medical management, and any other unit providing services directly to Enrollees; (31) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (34) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook handbook, within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Department shall develop a model Enrollee handbook and shall designate which areas the Contractor is allowed to customize. The Contractor shall use the model Enrollee handbook developed by the date specified by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customize. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharing, and how transportation is provided; (4) regarding cost sharing on any benefits provided by the Contractor; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (65) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled; (76) on the Contractor’s procedures for obtaining benefits, including Service Authorization service authorization requirements and/or referrals for specialty care; (8) 7) on the extent to which, and how, after-hours care is provided; (9) 8) on how emergency care is provided; (109) regarding what constitutes an Emergency Medical Condition; (1110) regarding what constitutes an Emergency Service; (1211) that prior authorization is not required for Emergency Services; (1312) that the Enrollee has the right to use any hospital or other setting for emergency care; (1413) that includes on cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (1514) on the Poststabilization Post-stabilization Care Services rules set forth at 42 CFR § 422.113(c); (1615) on any restrictions on the Enrollee’s freedom of choice among Network Providers; (1716) on the extent to which, and how, Enrollees may obtain benefits from Non-Non- Network Providers;. (1817) on time frames for offering first service for emergent, urgent and non- non-urgent care specified in Article 10.4.4 of this attachment;Contract. (1918) on Enrollee rights as outlined in Article 9.1.2 of this attachmentand responsibilities, including the Enrollee’s right to: (i) receive information on beneficiary and plan information; (20ii) be treated with respect and with due consideration for the Enrollee’s dignity and privacy; (iii) receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand; (iv) participate in decisions regarding the Enrollee’s health care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in other Federal regulations on the use of restraints and seclusion; (vi) if the privacy rule, as set forth in 45 CFR parts 160 and 164 subparts A and E applies, request and receive a copy of the Enrollee’s medical records and request that they be amended or corrected; (vii) be furnished health care services in accordance with access and quality standards; and (viii) be free to exercise all rights and that by exercising those rights, the Enrollee shall not be treated adversely by the Contractor, its Network Providers, or the Department. (19) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2120) on the Enrollee’s (or the Enrollee’s legal guardian’s or other authorized representative’s, or a provider’s) right to: (i) file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that which is adverse to the Enrollee; (2221) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2322) on the availability of assistance in the filing process for Grievances; (2423) on the availability of assistance in requesting Appeals; (2524) on the fact that, when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests an Appeal or a State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2625) that Indian Enrollees may obtain Covered Services directly from an IHCPIndian Health Care Provider; (27) that Enrollees may obtain Covered Services directly from an FQHC; (2826) on how to exercise an Advance Directive; (2927) on how to access auxiliary aids and services, including additional information in alternative formats or languages, at no cost; (3028) regarding the toll-free telephone numbers for Member Services, medical management, and any other unit providing services directly to Enrollees; (3129) on how to report suspected Fraud or Abuse; (30 that Enrollees may obtain Covered Services directly from an FQHC; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (34) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor. including information about the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharingEPSDT and transportation benefits delivered outside the Contractor, and how transportation is providedif any; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled;; and (7) procedures for obtaining benefits, including Service Authorization any requirements for service authorization and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) on the extent to which, and how, after-hours care is providedprovide; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the a right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Post-Stabilization Care Services rules set forth at 42 CFR § 422.113(c); (16422.113(c);(16) on any restrictions restriction on the Enrollee’s freedom of choice among Network Providers; (17) on the extent to which, and how, Enrollees may obtain benefits from Non-Network Providers; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachment; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachment; (20) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (21) on the Enrollee’s right to: (i) file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (22) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (23) on the availability of assistance in the filing process for Grievances; (24) on the availability of assistance in requesting Appeals; (25) on the fact that, when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests an Appeal or a State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (26) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHC; (28) on how to exercise an Advance Directive; (29) on how to access auxiliary aids and services, including additional information in alternative formats or languages, at no cost; (30) regarding the toll-free telephone numbers for Member Services, medical management, and any other unit providing services directly to Enrollees; (31) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (34) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The By July 1, 2018, the Contractor shall use the model Enrollee handbook developed by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Programmanaged care program; (2) on benefits provided by the Contractor. including information about the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharingEPSDT benefits delivered outside the Contractor, and how transportation is providedif any; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled;; and (7) procedures for obtaining benefits, including Service Authorization any requirements for service authorization and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) on the extent to which, and how, after-hours care is provided; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the a right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions on the Enrollee’s freedom of choice among Network Providers; (1716) on the extent to which, and how, Enrollees may obtain benefits including family planning services and supplies from Non-Network Providers; (17) that includes an explanation that Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (18) on time frames that includes cost sharing for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachmentservices furnished by the Contractor; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachmentand responsibilities, including the Enrollee’s right to: (i) receive information on beneficiary and plan information; (ii) be treated with respect and with due consideration for his or her dignity and privacy; (iii) receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand; (iv) participate in decisions regarding his or her health care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation; and (vi) request and receive a copy of their medical records and request that they be amended or corrected. (20) on Enrollee rights and responsibilities, including the Enrollee’s right to obtain available and accessible health care services covered under the Contract; (21) on the process of selecting and changing the Enrollee’s PCP; (22) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2123) on the Enrollee’s right to: (i) to file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (2224) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2325) on the availability of assistance in the filing process for Grievances; (2426) on the availability of assistance in requesting the filing process for Appeals; (2527) on the fact that, Enrollee’s right to request a State Fair Hearing after the Contractor has made a determination on an Enrollee’s appeal which is adverse to the Enrollee; (28) that when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests files an Appeal or a request for State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (26) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHC; (2829) on how to exercise an Advance Directive; (2930) on how to access auxiliary aids and services, including additional information in alternative formats or languages, at no cost; (3031) regarding the toll-free telephone numbers for Member Servicesmember services, medical management, and any other unit providing services directly to Enrollees; (3132) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law;; and (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (34) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use begin using the model Enrollee handbook developed by the Department within a timeframe specified by the Department. The Department shall designate which areas in the model Enrollee handbook that sections the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor;. (3) on how and where to access any benefits provided by the Department, including any cost sharing, and how transportation is provided; (4) regarding cost sharing on any benefits covered services provided by the Contractor;. (54) which details that in the case of a counseling or referral service that not covered by the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (65) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled;; and (76) procedures for obtaining benefits, including Service Authorization service authorization requirements and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) 7) on the extent to which, and how, after-hours care is provided; (9) 8) on how emergency care is provided; (109) regarding what constitutes an Emergency Medical Condition; (1110) regarding what constitutes an Emergency Service; (1211) that prior authorization is not required for Emergency Services; (1312) that the Enrollee has the a right to use any hospital or other setting for emergency care; (1413) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (1514) on the Poststabilization Post-Stabilization Care Services rules set forth at 42 CFR § 422.113(c); (1615) on any restrictions on the Enrollee’s freedom of choice among Network Providers; (1716) on the extent to which, and how, Enrollees may obtain benefits including family planning services and supplies from Non-Network Providers; (17) that includes an explanation that the Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (18) on time frames that includes cost sharing for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachmentservices furnished by the Contractor; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachmentand responsibilities, including the Enrollee’s right to: (i) receive information on Enrollee and Contractor information; (ii) be treated with respect and with due consideration for the Enrollee’s dignity and privacy; (iii) receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand; (iv) participate in decisions regarding the Enrollee’s health care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in Federal regulations on the use of restraints and seclusion; and (vi) request and receive a copy of Enrollee’s medical records and request that they be amended or corrected. (vii) obtain available and accessible health care services covered under the Contract. (20) on the process of selecting and changing the Enrollee’s PCP; (21) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2122) on the Enrollee’s right to: (i) to file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (2223) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2324) on the availability of assistance in the filing process for Grievances; (2425) on the availability of assistance in requesting the filing process for Appeals; (2526) on the fact that, Enrollee’s right to request a State Fair Hearing after the Contractor has made a determination on an Enrollee’s appeal which is adverse to the Enrollee; (27) that when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests files an Appeal or a request for State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2628) that Indian Enrollees may obtain Covered Services directly from an IHCPIndian Health Care Provider; (2729) that Enrollees may obtain Covered Services directly from an FQHC; (2830) on how to exercise an Advance Directive; (2931) on how to access auxiliary aids and services, including additional information in alternative formats or languages, languages at no cost; (3032) regarding the toll-free telephone numbers for Member Servicesmember services, medical management, and any other unit providing services directly to Enrollees; (3133) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (34) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customize. (C) The Contractor shall ensure that its Enrollee handbook contains the following information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor, including information about the EPSDT benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharing, EPSDT benefits delivered outside the Contractor, if any, and how transportation is provided; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled; (7) procedures for obtaining benefits, including Service Authorization requirements and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) on the extent to which, and how, after-hours care is provided; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions on the Enrollee’s freedom of choice among Network Providers; (17) on the extent to which, and how, Enrollees may obtain benefits benefits, including family planning services and supplies from Non-Network Providers; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachmentthat includes an explanation that the Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachment; (20) on the process of selecting and changing the Enrollee’s PCP; (21) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2122) on the Enrollee’s right to: (i) file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (2223) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2324) on the availability of assistance in the filing process for Grievances; (2425) on the availability of assistance in requesting Appeals; (2526) on the fact that, when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests an Appeal or a State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2627) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHC; (28) on how to exercise an Advance Directive; (29) on how to access auxiliary aids and services, including additional information in alternative formats or languages, at no cost; (30) regarding the toll-free telephone numbers for Member Services, medical management, and any other unit providing services directly to Enrollees; (31) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (3433) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall develop a model Enrollee handbook and shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor. including information about the EPSDT benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharing, EPSDT benefits delivered outside the Contractor, if any, and how transportation is provided; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled; (7) procedures for obtaining benefits, including Service Authorization service authorization requirements and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) on the extent to which, and how, after-hours care is provided; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Post-Stabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions restriction on the Enrollee’s freedom of choice among Network Providers; (17) on the extent to which, and how, Enrollees may obtain benefits benefits, including family planning services and supplies from Non-Network Providers; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachmentthat includes an explanation that Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachmentand responsibilities, including the Enrollee’s right to: (i) receive information on beneficiary and plan information; (ii) be treated with respect and with due consideration for the Enrollee’s dignity and privacy; (iii) receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand; (iv) participate in decisions regarding the Enrollee’s health care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation; (vi) request and receive a copy of the Enrollee’s medical records and request that they be amended or corrected; (vii) be furnished health care services in accordance with access and quality standards and accessible health care services covered under the Contract; (viii) be free to exercise all rights and that by exercising those rights, the Enrollee shall not be treated adversely by the Contractor, its Network Providers, or the Department; and (ix) obtain available and accessible health care services covered under the Contract. (20) on the process of selecting and changing the Enrollee’s PCP; (21) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2122) on the Enrollee’s (or the Enrollee’s legal guardian’s or other authorized representative’s, or a Provider’s) right to: (i) file Grievances and request Appeals; and (ii) request Request a State Fair Hearing after the Contractor has made a determination on the Appeal that which is adverse to the Enrollee; (2223) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2324) on the availability of assistance in the filing process for Grievances; (2425) on the availability of assistance in requesting Appeals; (2526) on the Enrollee’s right to request a State Fair hearing after the Contractor has made a determination on an Enrollee’s appeal which is adverse to the Enrollee; (27) on the fact that, when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests an Appeal or a State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the outcome of the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2628) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHC; (28) on how to exercise an Advance DirectiveIndian Health Care Provider; (29) on Advance Directives policies, including a description of applicable State law; (30) on how to access auxiliary aids and services, including additional information in alternative formats or languages, languages at no cost; (3031) regarding the toll-free telephone numbers for Member Servicesmember services, medical management, and any other unit providing services directly to Enrollees; (3132) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (34) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor;. (3) on how and where to access any benefits provided by the Department, including any cost sharing, and how transportation is provided; (4) regarding cost sharing on any benefits provided by the Contractor;contractor. (54) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (65) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled;; and (76) procedures for obtaining benefits, including Service Authorization any requirements for service authorization and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) 7) on the extent to which, and how, after-hours care is provided; (9) 8) on how emergency care is provided; (109) regarding what constitutes an Emergency Medical Condition; (1110) regarding what constitutes an Emergency Service; (1211) that prior authorization is not required for Emergency Services; (1312) that the Enrollee has the a right to use any hospital or other setting for emergency care; (1413) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (1514) on the Poststabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions on the Enrollee’s freedom of choice among Network Providers; (1715) on the extent to which, and how, Enrollees may obtain benefits including family planning services and supplies from Non-Network Providers; (16) that includes an explanation that the Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (17) that includes cost sharing for services furnished by the Contractor; (18) on time frames Enrollee rights and responsibilities, including the Enrollee’s right to: (i) receive information on Enrollee and Contractor information; (ii) be treated with respect and with due consideration for offering first service for emergentthe Enrollee’sdignity and privacy; (iii) receive information on available treatment options and alternatives, urgent presented in a manner appropriate to the Enrollee’s condition and non- urgent care ability to understand; (iv) participate in decisions regarding the Enrollee’shealth care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in Article 10.4.4 Federal regulations on the use of this attachment;restraints and seclusion; and (vi) request and receive a copy of Enrollee’s medical records and request that they be amended or corrected. (vii) obtain available and accessible health care services covered under the Contract. (19) on Enrollee rights as outlined in Article 9.1.2 the process of this attachmentselecting and changing the Enrollee’s PCP; (20) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed develope by or described in a manner approved by the Department; (21) on the Enrollee’s right to: (i) to file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (22) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (23) on the availability of assistance in the filing process for Grievances; (24) on the availability of assistance in requesting the filing process for Appeals; (25) on the fact that, Enrollee’s right to request a State Fair Hearing after the Contractor has made a determination on an Enrollee’s appeal which is adverse to the Enrollee; (26) that when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests files an Appeal or a request for State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2627) that Indian Enrollees may obtain Covered Services directly from an IHCPIndian Health Care Provider; (2728) that Enrollees may obtain Covered Services directly from an FQHC; (2829) on how to exercise an Advance Directive; (2930) on how to access auxiliary aids and services, including additional information in alternative formats or languages, languages at no cost; (3031) regarding the toll-free telephone numbers for Member Servicesmember services, medical management, and any other unit providing services directly to Enrollees; (3132) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (3433) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall develop a model Enrollee handbook and shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor, including information about the EPSDT benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharing, EPSDT benefits delivered outside the Contractor, if any, and how transportation is provided; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled; (7) procedures for obtaining benefits, including Service Authorization service authorization requirements and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) on the extent to which, and how, after-hours care is provided; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Post-Stabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions restriction on the Enrollee’s freedom of choice among Network Providers; (17) on the extent to which, and how, Enrollees may obtain benefits benefits, including family planning services and supplies from Non-Network Providers; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachmentthat includes an explanation that Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachmentand responsibilities, including the Enrollee’s right to: (i) receive information on beneficiary and plan information; (ii) be treated with respect and with due consideration for the Enrollee’s dignity and privacy; (iii) receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand; (iv) participate in decisions regarding the Enrollee’s health care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation; (vi) request and receive a copy of the Enrollee’s medical records and request that they be amended or corrected; (vii) be furnished health care services in accordance with access and quality standards and accessible health care services covered under the Contract; (viii) be free to exercise all rights and that by exercising those rights, the Enrollee shall not be treated adversely by the Contractor, its Network Providers, or the Department; and (ix) obtain available and accessible health care services covered under the Contract. (20) on the process of selecting and changing the Enrollee’s PCP; (21) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2122) on the Enrollee’s (or the Enrollee’s legal guardian’s or other authorized representative’s, or a Provider’s) right to: (i) file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that which is adverse to the Enrollee; (2223) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2324) on the availability of assistance in the filing process for Grievances; (2425) on the availability of assistance in requesting Appeals; (2526) on the fact that, when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests an Appeal or a State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the outcome of the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2627) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHCIndian Health Care Provider; (28) on how to exercise an Advance DirectiveDirectives policies, including a description of applicable State law; (29) on how to access auxiliary aids and services, including additional information in alternative formats or languages, languages at no cost; (30) regarding the toll-free telephone numbers for Member Services, medical management, and any other unit providing services directly to Enrollees; (31) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (3433) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The By July 1, 2018, the Contractor shall use the model Enrollee handbook developed by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Programmanaged care program; (2) on benefits provided by the Contractor. including information about the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharingEPSDT and transportation benefits delivered outside the Contractor, and how transportation is providedif any; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled;; and (7) procedures for obtaining benefits, including Service Authorization any requirements for service authorization and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) on the extent to which, and how, after-hours care is providedprovide; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the a right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on Enrollee rights and responsibilities, including the Poststabilization Care Services rules set forth at 42 CFR § 422.113(c)Enrollee’s right to: (i) receive information on beneficiary and plan information; (ii) be treated with respect and with due consideration for his or her dignity and privacy; (iii) receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand; (iv) participate in decisions regarding his or her health care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation; and (vi) request and receive a copy of their medical records and request that they be amended or corrected. (16) on any restrictions on Enrollee rights and responsibilities, including the Enrollee’s freedom of choice among Network Providersright to obtain available and accessible health care services covered under the Contract; (17) on the extent to which, process of selecting and how, Enrollees may obtain benefits from Non-Network Providerschanging the Enrollee’s PCP; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachment; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachment; (20) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2119) on the Enrollee’s right to: (i) to file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (2220) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2321) on the availability of assistance in the filing process for Grievances; (2422) on the availability of assistance in requesting the filing process for Appeals; (2523) on the fact that, Enrollee’s right to request a State Fair Hearing after the Contractor has made a determination on an Enrollee’s appeal which is adverse to the Enrollee; (24) that when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests files an Appeal or a request for State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (26) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHC; (2825) on how to exercise an Advance Directive, if the Contractor has any of the following in its network: hospitals, critical access hospitals, home health agencies, Providers of home health care, Providers of personal care services, hospices, and religious nonmedical health care institutions; (2926) on how to access auxiliary aids and services, including additional information in alternative formats or languages, at no cost; (3027) regarding the toll-free telephone numbers for Member Servicesmember services, medical management, and any other unit providing services directly to Enrollees; (3128) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (3429) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall develop a model Enrollee handbook and shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customizecustomize in the model Enrollee handbook. (C) The Contractor shall ensure that its Enrollee handbook contains the following shall contain information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor. including information about the EPSDT benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharing, EPSDT benefits delivered outside the Contractor, if any, and how transportation is provided; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled; (7) procedures for obtaining benefits, including Service Authorization service authorization requirements and/or referrals for specialty carecare and for other benefits not furnished by the Enrollee’s PCP; (8) on the extent to which, and how, after-hours care is provided; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the right to use any hospital or other setting for emergency care; (14) that includes on cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Post-Stabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions restriction on the Enrollee’s freedom of choice among Network Providers; (17) on the extent to which, and how, Enrollees may obtain benefits benefits, including family planning services and supplies from Non-Network Providers; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachmentthat includes an explanation that Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachmentand responsibilities, including the Enrollee’s right to: (i) receive information on beneficiary and plan information; (ii) be treated with respect and with due consideration for the Enrollee’s dignity and privacy; (iii) receive information on available treatment options and alternatives, presented in a manner appropriate to the Enrollee’s condition and ability to understand; (iv) participate in decisions regarding the Enrollee’s health care, including the right to refuse treatment; (v) be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation; (vi) request and receive a copy of the Enrollee’s medical records and request that they be amended or corrected; and (vii) obtain available and accessible health care services covered under the Contract. (20) on the process of selecting and changing the Enrollee’s PCP; (21) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2122) on the Enrollee’s right to: (i) to file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (2223) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2324) on the availability of assistance in the filing process for Grievances; (2425) on the availability of assistance in requesting the filing process for Appeals; (2526) on the fact that, Enrollee’s right to request a State Fair Hearing after the Contractor has made a determination on an Enrollee’s appeal which is adverse to the Enrollee; (27) that when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests files an Appeal or a request for State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State state policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2628) that Indian Enrollees may obtain Covered Services directly from an IHCPIndian Health Care Provider; (27) that Enrollees may obtain Covered Services directly from an FQHC; (2829) on how to exercise an Advance Directive; (2930) on how to access auxiliary aids and services, including additional information in alternative formats or languages, languages at no cost; (3031) regarding the toll-free telephone numbers for Member Servicesmember services, medical management, and any other unit providing services directly to Enrollees; (3132) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (34) on any other content required by the Department.

Enrollee Handbook. (A) The Contractor shall provide each Enrollee an Enrollee handbook within a reasonable time after receiving notice of the Enrollee’s enrollment. (B) The Contractor shall use the model Enrollee handbook developed by the Department. The Department shall designate which areas in the model Enrollee handbook that the Contractor is allowed to customize. (C) The Contractor shall ensure that its Enrollee handbook contains the following information: (1) that enables the Enrollee to understand how to effectively use the Contractor’s Managed Care Program; (2) on benefits provided by the Contractor, including information about the EPSDT benefit and how to access component services if individuals under age 21 entitled to the EPSDT benefit are enrolled with the Contractor; (3) on how and where to access any benefits provided by the Department, including any cost sharing, including any cost sharing, EPSDT benefits delivered outside the Contractor, if any, and how transportation is provided; (4) regarding cost sharing on any benefits carved out of the Contract and provided by the ContractorDepartment; (5) which details that in the case of a counseling or referral service that the Contractor does not cover because of moral or religious objections, the Contractor shall inform Enrollees that the service is not covered by the Contractor and how they can obtain information from the Department about how to access those services; (6) on the amount, duration, and scope of benefits available under the Contract in sufficient detail to ensure that Enrollees understand the benefits to which they are entitled; (7) procedures for obtaining benefits, including Service Authorization requirements and/or referrals for specialty carecare and for other benefits not furnshed by the Enrollee's PCP; (8) on the extent to which, and how, after-hours care is provided; (9) on how emergency care is provided; (10) regarding what constitutes an Emergency Medical Condition; (11) regarding what constitutes an Emergency Service; (12) that prior authorization is not required for Emergency Services; (13) that the Enrollee has the right to use any hospital or other setting for emergency care; (14) that includes cost sharing for services furnished by the Contractor, if any is imposed under the State Plan; (15) on the Poststabilization Care Services rules set forth at 42 CFR § 422.113(c); (16) on any restrictions on the Enrollee’s freedom of choice among Network Providers; (17) on the extent to which, and how, Enrollees may obtain benefits benefits, including family planning services and supplies, from Non-Network Providers; (18) on time frames for offering first service for emergent, urgent and non- urgent care specified in Article 10.4.4 of this attachmentthat includes an explanation that the Contractor cannot require an Enrollee to obtain a referral before choosing a family planning Provider; (19) on Enrollee rights as outlined in Article 9.1.2 of this attachment; (20) on the process of selecting and changing the Enrollee’s PCP; (21) on Grievance, Appeal, and State Fair Hearing procedures and timeframes developed by or described in a manner approved by the Department; (2122) on the Enrollee’s right to: (i) file Grievances and request Appeals; and (ii) request a State Fair Hearing after the Contractor has made a determination on the Appeal that is adverse to the Enrollee; (2223) on the requirements and timeframes for filing a Grievance or requesting an Appeal; (2324) on the availability of assistance in the filing process for Grievances; (2425) on the availability of assistance in requesting Appeals; (2526) on the fact that, when requested by the Enrollee, benefits that the Contractor seeks to reduce or terminate will continue if the Enrollee requests an Appeal or a State Fair Hearing within the timeframes specified for filing, and requests continuation of services within the required timeframe, and that the Enrollee may, consistent with State policy, be required to pay the cost of services furnished while the Appeal or State Fair Hearing is pending if the final decision is adverse to the Enrollee; (2627) that Indian Enrollees may obtain Covered Services directly from an IHCP; (27) that Enrollees may obtain Covered Services directly from an FQHC; (28) on how to exercise an Advance Directive; (29) on how to access auxiliary aids and services, including additional information in alternative formats or languages, at no cost; (30) regarding the toll-free telephone numbers for Member Services, medical management, and any other unit providing services directly to Enrollees; (31) on how to report suspected Fraud or Abuse; (32) on Advance Directives policies, including a description of applicable State law; (33) that describe the transition of care policies for Enrollees and Potential Enrollees; and (3433) on any other content required by the Department.