Common use of Enrollee information Requirements, Generally Clause in Contracts

Enrollee information Requirements, Generally. (A) The Contractor shall write all Enrollee and Potential Enrollee informational, instructional, and educational materials, in a manner that may be easily understood at a sixth grade reading level. (B) The Enrollee information required under Article 3.6 may not be provided electronically unless: (1) it is in a format that is Readily Accessible; (2) the information is placed on a location in the Contractor’s website that is prominent and Readily Accessible; (3) the information is in an electronic form which can be electronically retained and printed; (4) the information is consistent with content and language requirements; and (5) the Contractor notifies the Enrollee that the information is available in paper form within five business days. (C) The Contractor shall have mechanisms in place to help Enrollees and Potential Enrollees understand the requirements and benefits of their plan. (D) The Contractor shall make auxiliary aids and services available upon request of the Potential Enrollee or Enrollee at no cost, and in a manner that takes into consideration the special needs of Potential Enrollees or Enrollees with disabilities or limited English proficiency. (E) The Contractor shall make interpretation services, including oral interpretation and the use of auxiliary aids such as TTY/TDY and American Sign language (ASL), free of charge to each Enrollee. (F) The Contractor shall notify its Enrollees that: (1) Oral interpretation is available for any language, and how to access those services; (2) Written translation is available in prevalent languages, and how to access those services; and (3) Auxiliary aids and services are available upon request at no cost for Enrollees with disabilities, and how to access those services. (G) The Contractor shall provide adult Enrollees with written information on Advance Directives policies, including a description of applicable State law. The information on Advance Directives provided to adult Enrollees must reflect changes in State law as soon as possible but no later than 90 calendar days after the effective date of the change. (H) The Contractor shall use the Department-developed definition for the following terms: (1) appeal; (2) co-payment; (3) durable medical equipment; (4) emergency medical condition; (5) emergency medical transportation; (6) emergency room care; (7) emergency services; (8) excluded services; (9) grievance; (10) habilitation services and devices; (11) health insurance; (12) home health care; (13) hospice services; (14) hospitalization; (15) hospital outpatient care; (16) medically necessary; (17) network; (18) network provider; (19) non-participating provider; (20) participating provider; (21) PCD; (22) physician services; (23) plan; (24) preauthorization; (25) premium; (26) prescription drug coverage; (27) prescription drugs; (28) primary care physician; (29) provider; (30) rehabilitation services and devices; (31) skilled nursing care; (32) specialist; and (33) urgent care. (I) The Contractor shall use Enrollee notices developed by the Department.

Enrollee information Requirements, Generally. (A) The Contractor shall write all Enrollee and Potential Enrollee informational, instructionalinstruction, and educational materials, in a manner that may be easily understood at a sixth grade reading level. (B) Once a year, the Contractor shall notify all Enrollees of their right to request and obtain the Contractor’s member handbook. (C) The Enrollee information required under this Article 3.6 may not be provided electronically unless: (1) it is in a format that is Readily Accessible; (2) the information is placed on a location in the Contractor’s website that is prominent and Readily Accessible; (3) the information is in an electronic form which can be electronically retained and printed; (4) the information is consistent with content and language requirements; and (5) the Contractor notifies the Enrollee that the information is available in paper form within five business days. (CD) The Contractor shall have mechanisms in place to help Enrollees and Potential Enrollees understand the requirements and benefits of their plan.plan.x (DE) The Contractor shall make auxiliary aids and services available upon request of the Potential Enrollee or Enrollee at no cost, and in a manner that takes into consideration the special needs of Potential Enrollees or Enrollees with disabilities or limited English proficiency. (EF) The Contractor shall make interpretation services, including oral interpretation and the use of auxiliary aids such as TTY/TDY TTD and American Sign language Language (ASL), free of charge to each Enrollee. (FG) The Contractor shall notify its Enrollees that: (1) Oral interpretation is available for any language, and how to access those services; (2) Written translation is available in prevalent languages, and how to access those services; and (3) Auxiliary aids and services are available upon request at no cost for Enrollees with disabilities, and how to access those services. (GH) The Contractor shall provide adult Enrollees with written information on Advance Directives policies, including a description of applicable State law. The information on Advance Directives provided to adult Enrollees must reflect changes in State law as soon as possible but no later than 90 calendar days after the effective date of the change. (HI) The Contractor shall use the Department-developed definition for the following terms: (1) : appeal; (2) ; co-payment; (3) ; durable medical equipment; (4) ; emergency medical condition; (5) ; emergency medical transportation; (6) ; emergency room care; (7) ; emergency services; (8) ; excluded services; (9) ; grievance; (10) ; habilitation services and devices; (11) ; health insurance; (12) ; home health care; (13) ; hospice services; (14) ; hospitalization; (15) ; hospital outpatient care; (16) ; medically necessary; (17) ; network; (18) network provider; (19) ; non-participating provider; (20) ; participating provider; (21) PCD; (22) ; plan; physician services; (23) plan; (24) ; preauthorization; (25) ; premium; (26) ; prescription drug coverage; (27) ; prescription drugs; (28) ; primary care physician; (29) ; PCP; provider; (30) ; rehabilitation services and devices; (31) ; skilled nursing care; (32) ; specialist; and (33) and urgent care. (IJ) The Contractor shall use Enrollee notices developed by the Department. The Contractor shall ensure that the Enrollee notices developed by the Department are in use by July 1, 2018.

Enrollee information Requirements, Generally. (A) The Contractor shall write all Enrollee and Potential Enrollee informational, instructional, and educational materials, in a manner that may be easily understood at a sixth grade reading level. (B) The Enrollee information required under Article 3.6 may not be provided electronically unless: (1) it is in a format that is Readily Accessible; (2) the information is placed on a location in the Contractor’s website that is prominent and Readily Accessible; (3) the information is in an electronic form which can be electronically retained and printed; (4) the information is consistent with content and language requirements; and (5) the Contractor notifies the Enrollee that the information is available in paper form within five business days. (C) The Contractor shall have mechanisms in place to help Enrollees and Potential Enrollees understand the requirements and benefits of their plan. (D) The Contractor shall make auxiliary aids and services available upon request of the Potential Enrollee or Enrollee at no cost, and in a manner that takes into consideration the special needs of Potential Enrollees or Enrollees with disabilities or limited English proficiency. (E) The Contractor shall make interpretation services, including oral interpretation and the use of auxiliary aids such as TTY/TDY TTD and American Sign language Language (ASL), free of charge to each Enrollee. (F) The Contractor shall notify its Enrollees that: (1) Oral interpretation is available for any language, and how to access those services; (2) Written translation is available in prevalent languages, and how to access those services; and (3) Auxiliary aids and services are available upon request at no cost for Enrollees with disabilities, and how to access those services. (G) The Contractor shall provide adult Enrollees with written information on Advance Directives policies, including a description of applicable State law. The information on Advance Directives provided to adult Enrollees must reflect changes in State law as soon as possible but no later than 90 calendar days after the effective date of the change. (H) The Contractor shall use the Department-developed definition for the following terms: (1) appeal; (2) co-payment; (3) durable medical equipment; (4) emergency medical condition; (5) emergency medical transportation; (6) emergency room care; (7) emergency services; (8) excluded services; (9) grievance; (10) habilitation services and devices; (11) health insurance; (12) home health care; (13) hospice services; (14) hospitalization; (15) hospital outpatient care; (16) medically necessary; (17) network; (18) network provider; (19) non-participating provider; (20) participating provider; (21) PCD; (22) physician services; (23) plan; (24) preauthorization; (25) premium; (26) prescription drug coverage; (27) prescription drugs; (28) primary care physician; (29) provider; (30) rehabilitation services and devices; (31) skilled nursing care; (32) specialist; and (33) urgent care. (I) The Contractor shall use Enrollee notices developed by the Department.