Enrollee Notification. The Contractor shall issue Contractor plan materials and information to all new enrollees prior to the effective date of enrollment or within seven (7) calendar days following the receipt of weekly enrollment file specified above, or, in case of retroactive enrollment, issue the materials by the 1st of the subsequent month or within seven (7) calendar days following receipt of the weekly enrollment file. The specifications for the Contractor plan materials and information are listed in Article 5.8.
Enrollee Notification. Provider Termination
Enrollee Notification. The contractor shall provide written notification to its enrollees under twenty-one (21) years of age when appropriate periodic assessments or needed services are due and must coordinate appointments for care.
Enrollee Notification. The terminating and successor contractors shall notify enrollees of the pending transition, with all notices to be submitted to DMAHS for review and approval before mail out.
Enrollee Notification. A. General Requirements
Enrollee Notification. HANDBOOK Prior to the effective date of enrollment, the contractor shall provide each enrolled case or, where applicable, authorized person, with a bilingual (English/Spanish) member handbook and an Identification Card. The handbook shall be written at the fifth grade reading level or at an appropriate reading level for enrollees with special needs. The handbook shall also be available on request in other languages and alternative formats, e.g., large print, Braille, audio cassette, or diskette for enrollees with sensory impairments or in a modality that meets the needs of enrollees with special needs. The content and format of the handbook shall have the prior written approval of DMAHS and shall describe all services covered by the contractor, exclusions or limitations on coverage, the correct use of the contractor's plan, and other relevant information, including but not limited to the following:
A. Cover letter, explaining the member handbook, expected effective date of enrollment, and when identification card will be received (if not sent with the handbook);
1. The enrollee's expected effective date of enrollment; provided that, if the actual effective date of enrollment is different from that given to the enrollee or, where applicable, an authorized person, at the time of enrollment, the contractor shall notify the enrollee or, where applicable, an authorized person of the change;
B. A clear description of benefits included in this contract with exclusions, restrictions, and limitations. Clarification that enrollees who are clients of the Division of Developmental Disabilities will receive mental health/substance abuse services through the contractor (may be addressed through a separate insert to the basic handbook);
C. An explanation of the procedures for obtaining covered services;
D. An explanation of the use of the contractor's toll free telephone number (staffed for twenty-four (24) hours per day/seven (7) days per week communication);
E. A listing of primary care practitioners (in the format described in Article 4.8.4);
F. An identification card clearly indicating that the bearer is an enrollee of the contractor's plan; and the name of the primary care practitioner and telephone number on the card; a description of the enrollee identification card to be issued by the contractor; and an explanation as to its use in assisting beneficiaries to obtain services;
G. An explanation that beneficiaries shall obtain all covered non-emergency health care s...
Enrollee Notification
