Common use of Enrollee Materials Clause in Contracts

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. (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 CoverageCoveragesuch 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. (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) Drug formulary information (vii) Uniform summary of benefits and coverage (viii) 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;, 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’s compliance with the Performance Measurement Standards set forth in this Agreement. The enrollment packet shall include, at the minimum, the following: (a) Welcome letter; (b) Enrollee ID card;

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) 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) v. Termination Grievance process materials (vi) . Drug formulary information vii. Uniform summary of benefits and coverage viii. Other materials required by the Exchange. (c) New Enrollee Enrollment Packets. (i) 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 (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’s compliance with the Performance Measurement Standards set forth in this Agreement. The enrollment packet shall include, at the minimum, the following: a. Welcome letter; b. Enrollee ID card; c. Summary of Benefits and Coverage; d. Pharmacy benefit information; e. Nurse advice line information; and f. Other materials required by the Exchange. ii. Contractor shall maintain access to enrollment packet materials; Summary of Benefits and Coverage (“SBC”); claim forms and other Plan- related documents in both English and Spanish and any other languages required by State and Federal laws, rules and regulations to the extent required to timely meet all requirements of this Agreement for timely mailing and delivery of Plan materials to Enrollees. Contractor shall be responsible for printing, storing and stocking, as applicable, all materials.

Enrollee Materials. (ai) 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 threshold languages as required by Federal and State law and receive any necessary regulatory approvals from Health Care Regulators, Regulators and be provided to the Exchange as directed by the Exchange, Exchange and shall include information brochures, brochures a summary of the Plan that accurately reflects the coverage available under the Plan (a Summary of Benefits and Coveragesuch 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 enrollee communications and give the Exchange the opportunity to comment and suggest changes in such material. (bii) 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, 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: (i) a. Welcome letters (ii) Enrollee ID card (iii) b. Billing notices and statements (iv) c. Notices of actions to be taken by Plan that may impact coverage or benefit benefit d. Termination letters (v) Termination e. Grievance process materials (vi) f. Drug formulary information g. Uniform summary of benefits and coverage h. Other materials required by the Exchange. (ciii) New Enrollee Enrollment Packets. (i) a. Contractor shall mail 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 enrollee materials pursuant to other methods that are consistent with; with (1i) Contractor’s submission of materials to enrollees of its other plans; , (2ii) the needs of Enrollees; , (3iii) 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 with the Performance Measurement Standards set forth in this Agreement. The enrollment packet shall include, at the minimum, the following: i. Welcome letter; ii. Enrollee ID card; iii. Benefit summary; iv. Pharmacy benefit information; v. Nurse advice line information; and vi. Other materials required by the Exchange. b. Contractor shall maintain access to enrollment packet materials, Summary of Benefits and Coverage (“SBC”), claim forms and other Plan-related documents in both English and Spanish and any other languages required by State and Federal laws, rules and regulations to the extent required to timely meet all requirements of this Agreement for timely mailing and delivery of Plan materials to Enrollees. Contractor shall be responsible for printing, storing and stocking, as applicable, all materials.

Enrollee Materials. (ai) 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 threshold languages as required by Federal and State law and receive any necessary regulatory approvals from Health Care Regulators, Regulators and be provided to the Exchange as directed by the Exchange, Exchange and shall include information brochures, brochures a summary of the Plan that accurately reflects the coverage available under the Plan (a Summary of Benefits and Coveragesuch 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 enrollee communications and give the Exchange the opportunity to comment and suggest changes in such material. (bii) 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, 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: (i) a. Welcome letters (ii) Enrollee ID card (iii) b. Billing notices and statements (iv) c. Notices of actions to be taken by Plan that may impact coverage or benefit benefit d. Termination letters (v) Termination e. Grievance process materials (vi) f. Drug formulary information g. Uniform summary of benefits and coverage h. Other materials required by the Exchange. (ciii) New Enrollee Enrollment Packets. (i) a. Contractor shall mail 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 enrollee materials pursuant to other methods that are consistent with; with (1i) Contractor’s submission of materials to enrollees of its other plans; , (2ii) the needs of Enrollees; , (3iii) 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 with the Performance Measurement Standards set forth in this Agreement. The enrollment packet shall include, at the minimum, the following: i. Welcome letter; ii. Enrollee ID card; iii. Benefit summary; iv. Pharmacy benefit information; v. Nurse advice line information; and vi. Other materials required by the Exchange. b. Contractor shall maintain access to enrollment packet materials, Summary of Benefits and Coverage (“SBC”), claim forms and other Plan-related documents in both English and Spanish and any other languages required by State and Federal laws, rules and regulations to the extent required to timely meet all requirements of this Agreement for timely mailing and delivery of Plan materials to Enrollees. Contractor shall be responsible for printing, storing and stocking, as applicable, all materials.

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 in individual QDPs within ten (10) business days of receiving complete and accurate enrollment verification information from the ExchangeExchange 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; andand (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’s compliance with the Performance Measurement Standards set forth in this Agreement. The enrollment packet shall include, at the minimum, the following: (a) Welcome letter; (b) Enrollee ID card; in a form approved by the Exchange, or communication approved by the Exchange issued to Enrollee regarding use of approved no-card eligibility verification system 1. If Enrollee ID card is not included in the enrollment packet, Contractor must send a notice to the Enrollee that states the ID card will be sent separately, and when the Enrollee should expect to receive it,. (c) Other materials required by the Exchange. (ii) Contractor shall maintain access to enrollment packet materials; claim forms and other Plan-related documents in both English and Spanish and any other languages required by State and Federal laws, rules and regulations to the extent required to timely meet all requirements of this Agreement for timely mailing and delivery of Plan materials to Enrollees. Contractor shall be responsible for printing, storing and stocking, as applicable, all materials.