Enrollee Materials. Upon request, Contractor shall provide the Exchange with at least one (1) copy, unless otherwise specified, of any information Contractor intends to mail to all the Exchange Enrollees, including, but not limited to, Evidence of Coverage and disclosure forms, enrollee newsletters, new enrollee materials, health education materials, and special announcements. The materials provided to the Exchange under this Section will not require prior-approval by the Exchange before the Contractor distributes such materials; provided, however, that Contractor shall duly evaluate any changes proposed by the Exchange with respect to such materials. Contractor shall maintain an electronic file that is open to the Exchange. Such file shall be accessible by the Exchange as required by applicable laws, rules and regulations and as otherwise mutually agreed upon by the parties.
Enrollee Materials. Basic Requirements
a) Contractor shall provide or make available to Enrollees Plan materials required under the terms of the Agreement and applicable laws, rules and regulations. Such materials shall be available in languages as required by Federal and State law and receive any necessary regulatory approvals from the relevant State Regulators, be provided to Covered California as directed by Covered California, and shall include information brochures, a summary of the Plan that accurately reflects the coverage available under the Plan (a Summary of Benefits and Coverage), and related communication materials. Contractor shall, upon request by Covered California, provide copies of Enrollee communications and give Covered California the opportunity to comment and suggest changes in such material.
b) Enrollee materials shall be available in English, Spanish and other languages as required by applicable laws, rules and regulations. Contractor shall comply with Federal and State laws, rules and regulations regarding language access. To the extent possible, Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulations. Plan materials that require Covered California notification before usage are those that communicate specific eligibility and enrollment and other key information to Enrollees. Such materials may include, but are not limited to:
i. Welcome letters;
ii. Enrollee identification card;
iii. Billing notices and statements;
iv. Notices of actions to be taken by QHP Issuer that may impact coverage or benefit letters;
v. Termination Grievance process materials;
vi. Drug formulary information;
vii. Uniform Summary of Benefits and Coverage; and
viii. Other materials required by Covered California.
Enrollee Materials. Basic Requirements
a) Contractor shall provide or make available to Enrollees Plan materials required under the terms of the Agreement and applicable laws, rules and regulations. Such materials shall be available in languages as required by Federal and State law and receive any necessary regulatory approvals from the relevant Regulators, be provided to the Exchange as directed by the Exchange, and shall include information brochures, a summary of the Plan that accurately reflects the coverage available under the Plan (a Summary of Benefits and Coverage) and related communication materials. Contractor shall, upon request by the Exchange, provide copies of Enrollee communications and give the Exchange the opportunity to comment and suggest changes in such material.
b) Enrollee materials shall be available in English, Spanish and other languages as required by applicable laws, rules and regulations. Contractor shall comply with Federal and State laws, rules and regulations regarding language access. To the extent possible, Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulations. Plan materials that require Exchange notification before usage are those that communicate specific eligibility and enrollment and other key information to Enrollees. Such materials may include, but are not limited to:
i. Welcome letters;
ii. Enrollee ID card with the same product name as used in the Covered CA and issuer websites; iii Billing notices and statements;
Enrollee Materials. Insurer is responsible for all preparation, cost, and distribution of Enrollee materials. Insurer shall provide all materials to Enrollees and potential Enrollees in a manner and format that may be easily understood and is readily accessible in accordance with 42 CFR 457.1207, which incorporates 42 CFR 438.10. Insurer agrees to follow best practices related to accessibility of materials insofar as such best practices are reasonable and practicable. Insurer shall use a font size no smaller than 12-point in all written materials. Insurer shall make all written materials available in alternative formats and in a manner that takes into consideration the Enrollees’ special needs, including those who are visually impaired or have limited reading proficiency. Such alternative formats shall include auxiliary aids and services, oral interpretation in any language, and written interpretation in the language(s) prevalent in the Service Area. Insurer shall notify all Enrollees that information is available in alternative formats upon request at no cost. Insurer shall also inform Enrollees how to access such services. Written materials shall include a notice of nondiscrimination and taglines explaining the availability of written or oral translation in the prevalent non-English languages in the Service Area, as required by Section 1557 of the Affordable Care Act, as well as in large print, which means printed in a font size no smaller than 18-point. Insurer shall use the top fifteen (15) prevalent non-English languages determined by HHS unless otherwise approved by FHKC to use another source Insurer believes is more accurate. Insurer shall inform FHKC of the intended method(s) Insurer will use to distribute Enrollee materials. FHKC may require Insurer use or refrain from using certain method(s). Insurer shall make good faith efforts to contact or provide materials through alternate, allowable, methods to Enrollees when mail or other communication is returned undeliverable.
Enrollee Materials. (a) Contractor or its QHP bundled partner shall provide or make available to Enrollees Plan materials required under the terms of the Agreement and applicable laws, rules and regulations. Such materials shall be available in languages as required by Federal and State law and receive any necessary regulatory approvals from Health Care Regulators, be provided to the Exchange as directed by the Exchange, and shall include information brochures, a summary of the Plan that accurately reflects the coverage available under the Plan (a Summary of Benefits and Coverage) and related communication materials. Contractor shall, upon request by the Exchange, provide copies of Enrollee communications and give the Exchange the opportunity to comment and suggest changes in such material.
(b) Enrollee materials shall be available in English, Spanish and other languages as required by applicable laws, rules and regulations. Contractor shall comply with Federal and State laws, rules and regulations regarding language access. To the extent possible, Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulations. Plan materials that require Exchange notification before usage are those that communicate specific eligibility and enrollment and other key information to Enrollees. Such materials may include, but are not limited to:
(i) Welcome letters
(ii) Enrollee ID card
(iii) Billing notices and statements
(iv) Notices of actions to be taken by Plan that may impact coverage or benefit letters
(v) Termination Grievance process materials
(vi) Other materials required by the Exchange.
(c) New Enrollee Enrollment Packets.
(i) Contractor shall mail or provide online enrollment packets to all new Enrollees within ten (10) business days of receiving enrollment verification from the Exchange. Contractor may deliver Enrollee materials pursuant to other methods that are consistent with; (1) Contractor’s submission of materials to enrollees of its other plans; (2) the needs of Enrollees; (3) the consent of the Enrollee; and
Enrollee Materials. (i) Contractor shall provide or make available to Enrollees Plan materials required under the terms of the Agreement and applicable laws, rules and regulations. Such materials shall be available in threshold languages as required by law and receive any necessary regulatory approvals from Health Care Regulators and be provided to the Exchange as directed by the Exchange and shall include information brochures a summary of the Plan that accurately reflects the coverage available under the Plan (such summary plan description or other summary hereinafter referred at times as “Plan Summary”) and related communication materials. Contractor shall, upon request by the Exchange, provide copies of enrollee communications and give the Exchange the opportunity to comment and suggest changes in such material.
(ii) Enrollee materials shall be available in English, Spanish and other languages as required by applicable laws, rules and regulations. Contractor shall comply with Federal and State laws, rules and regulations regarding language access. To the extent possible the Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulations. Plan materials that require the Exchange notification before usage are those that communicate specific eligibility and enrollment and other key information to Enrollees. Such materials may include, but are not limited to:
a. Welcome letters
b. Billing notices and statements
c. Notices of actions to be taken by Plan that may impact coverage or benefit
d. Termination letters
e. Grievance process materials
f. Drug formulary information
g. Uniform summary of benefits and coverage
h. Other materials required by the Exchange.
(iii) New Enrollee Enrollment Packets.
a. Contractor shall mail, or provide online if an Enrollee opts to receive information online, enrollment packets to all new Enrollees within ten (10) business days of receiving enrollment verification from the Exchange. Contractor may deliver enrollee materials pursuant to other methods that are consistent with (i) Contractor’s submission of materials to enrollees of its other plans, (ii) the needs of Enrollees, (iii) the consent of the Enrollee, and (iv) with applicable laws, rules and regulations. Contractor shall report to the Exchange monthly, in a format mutually agreed upon by the Exchange and Contractor on the number and accuracy rate of identification cards that were sent to new Enrollees and Contractor’s compliance wit...
Enrollee Materials. Branding Documents Contractor shall comply with the Exchange co- branding requirements relating to the format and use of the Exchange logo and information on premium invoices, ID cards and Enrollee termination notices. The Contractor shall include Exchange logo and other information in notices and other materials based upon the mutual agreement of the Exchange and Contractor regarding both which materials should include the Exchange logo and timing of its inclusion in Contractor-generated notices and other materials.
Enrollee Materials. (In addition to the submission requirements described below, the Contractor must maintain documentation verifying that the information conveyed in the following categories of Enrollee materials are reviewed on an ongoing basis for accuracy and updated at least annually)
(A) Certificate or Document of Coverage and Any Changes or Amendments. The Contractor shall submit these documents to the Department for prior approval initially and as revised.
Enrollee Materials. (a) Contractor shall provide or make available to Enrollees Plan materials required under the terms of the Agreement and applicable laws, rules and regulations. Such materials shall be available in languages as required by Federal and State law and receive any necessary regulatory approvals from Health Care Regulators, be provided to the Exchange as directed by the Exchange, and shall include information brochures, a summary of the Plan that accurately reflects the coverage available under the Plan (a Summary of Benefits and Coverage) and related communication materials. Contractor shall, upon request by the Exchange, provide copies of Enrollee communications and give the Exchange the opportunity to comment and suggest changes in such material.
(b) Enrollee materials shall be available in English, Spanish and other languages as required by applicable laws, rules and regulations. Contractor shall comply with Federal and State laws, rules and regulations regarding language access. To the extent possible, Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulations. Plan materials that require Exchange notification before usage are those that communicate specific eligibility and enrollment and other key information to Enrollees. Such materials may include, but are not limited to:
(i) Welcome letters
(ii) Enrollee ID card
(iii) Billing notices and statements
(iv) Notices of actions to be taken by Plan that may impact coverage or benefit letters
(v) Termination Grievance process materials
(vi) Other materials required by the Exchange.
(c) New Enrollee Enrollment Packets.
(i) Contractor shall mail or provide online enrollment packets to all new Enrollees in individual QDPs within ten (10) business days of receiving complete and accurate enrollment information from the Exchange and the binder payment and within ten (10) business days of receipt of complete and accurate enrollment information for SHOP QDP Enrollees. Contractor may deliver Enrollee materials pursuant to other methods that are consistent with; (1) Contractor’s submission of materials to enrollees of its other plans; (2) the needs of Enrollees; (3) the consent of the Enrollee; and (4) with applicable laws, rules and regulations. Contractor shall report to the Exchange monthly, in a format mutually agreed upon by the Exchange and Contractor, on the number and accuracy rate of identification cards that were sent to new Enrollees and Contractor...
Enrollee Materials. Basic Requirements
a) Contractor shall provide or make available to Enrollees Plan materials required under the terms of the Agreement and applicable laws, rules and regulations. Such materials shall be available in languages as required by Federal and State law and receive any necessary regulatory approvals from the relevant Regulators, be provided to the Exchange as directed by the Exchange, and shall include information brochures, a summary of the Plan that accurately reflects the coverage available under the Plan (a Summary of Benefits and Coverage), and related communication materials. Contractor shall, upon request by the Exchange, provide copies of Enrollee communications and give the Exchange the opportunity to comment and suggest changes in such material.
b) Enrollee materials shall be available in English, Spanish and other languages as required by applicable laws, rules and regulations. Contractor shall comply with Federal and State laws, rules and regulations regarding language access. To the extent possible, Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulations. Plan materials that require Exchange notification before usage are those that communicate specific eligibility and enrollment and other key information to Enrollees. Such materials may include, but are not limited to:
i. Welcome letters;
ii. Enrollee ID card with the same product name as used in the Covered California and QHP Issuer websites;
iii. Billing notices and statements;
iv. Notices of actions to be taken by QHP Issuer that may impact coverage or benefit letters;
v. Termination Grievance process materials;
vi. Drug formulary information;
vii. Uniform Summary of Benefits and Coverage; and
viii. Other materials required by the Exchange.
