Common use of Enrollee Materials Clause in Contracts

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 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. (i) Contractor shall provide or make available to Enrollees Plan materials required under the terms of the Agreement and applicable laws, rules and regulations, including new training materials under Section E(i) above . Such materials shall be available in threshold languages or as otherwise required by law and receive any necessary regulatory approvals from Health Care Regulators Regulatorions 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. Prior to use,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. all Plan materials shall be submitted to the Exchange for review and approval, including proposed updates or amendments. (ii) Enrollee materials shall be available in English, and 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. translate all written materials for Enrollees into Spanish and any language representing the preferred mode of communication for 3,000 or more Enrollees or as indicated on the enrollment file and/or as otherwise required by applicable laws, rules and regulations. Contractor shall ensure that Enrollees who are unable to read the written materials have an alternate form of access to the contents of the written materials. To the extent possible the Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulationsregulationsthe Regulations. Plan materials that require the Exchange review and approval 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 (ivivii) with applicable laws, rules and regulations; provided, however, that Contractor shall obtain Exchange’s prior approval with respect to any other method of delivery other than mailing. Contractor shall report to the Exchange monthly, in a format mutually agreed upon by the Exchange and Contractor Contractorand frequency determined by the Exchange, 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, Plan Summaries,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 regulationsunder law 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. (iv) Plan Summary of Benefits and Coverage. Contractor shall develop and maintain an SBC Plan Summary which shall accurately and completely describe the terms and conditions of the coverage and benefits provided under the Plan and the Participating Provider network as required by Federal and State laws, rules and regulations. The SBC The Plan Summary shall comply with state and federal laws, rules and regulations regarding disclosure of plan materials and be approved by Exchange. The Plan Summary shallwill be available to Enrollees online and shall be sent to Enrollees on request. The Plan Summary Plan Description available online and the hard copy sent to Enrollees on request shall be available to Enrollees in English, and Spanish, and other languages as required by Federal and State laws, rules and regulations. Contractor shall update the SBCPlan Summary Plan Description annually and Contractor shall make the SBCPlan Summary Plan Description available to Enrollees pursuant to Federal and State laws, rules and xxxxxxxxxxx.xx the time of their enrollment in the Plan, and annually thereafter at renewal if Plan benefits are modified, and as otherwise directed by the Exchange or required by law.

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, including new training materials under Section E(i) above . Such materials shall be available in threshold languages or as otherwise required by law and receive any necessary regulatory approvals from Health Care Regulators Regulations 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 shallPrior to use, upon request by the Exchange, provide copies of enrollee communications and give all Plan materials shall be submitted to the Exchange the opportunity to comment for review and suggest changes in such materialapproval, including proposed updates or amendments. (ii) Enrollee materials shall be available in English, English and Spanish. Contractor shall translate all written materials for Enrollees into Spanish and other languages any language representing the preferred mode of communication for 3,000 or more Enrollees or as indicated on the enrollment file and/or as otherwise required by applicable laws, rules and regulations. Contractor shall comply with Federal and State laws, rules and regulations regarding language accessensure that Enrollees who are unable to read the written materials have an alternate form of access to the contents of the written materials. To the extent possible the Enrollee materials shall be written in plain language, as that term is defined in applicable laws, rules and regulationsthe Regulations. Plan materials that require the Exchange notification review and approval 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, mail 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 (iviii) with applicable laws, rules and regulations; provided, however, that Contractor shall obtain Exchange’s prior approval with respect to any other method of delivery other than mailing. Contractor shall report to the Exchange monthlyExchange, in a format mutually agreed upon and frequency determined by the Exchange and Contractor Exchange, 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”)Plan Summaries, 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 under law 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. (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. 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.