Common use of Enrollee Services Clause in Contracts

Enrollee Services. ‌ Insurer shall maintain an enrollee service unit to provide enrollee-related customer service. The enrollee service unit shall have the ability to answer Enrollee inquiries by telephone, electronic communication and written communication. The enrollee service unit shall be accessible by a toll-free telephone number during the hours of 7:30 a.m. to 7:30 p.m. Eastern Time, Monday through Friday, except on state-recognized holidays. Insurer shall utilize automatic call distribution equipment and enrollee services representatives staffing sufficient to handle the expected volume of calls. Insurer shall also provide a telecommunication device for the deaf (TTY/TDD) and access to interpreter services. Insurer shall ensure enrollee services representatives are satisfactorily trained and capable of resolving Enrollee and potential Enrollee inquiries in all areas related to Florida Healthy Kids. Insurer’s enrollee services representatives shall be familiar with the basic eligibility requirements for the Florida Healthy Kids Program, but shall refer or transfer individuals with detailed questions or concerns to the Florida KidCare call center. Insurer shall monitor the enrollee services line to ensure Insurer meets certain performance standards and for quality assurance, including recording calls, conducting routine audits and other monitoring activities. Insurer shall meet the performance guarantees related to enrollee services included in Attachment C. Insurer shall provide a nurse line staffed by licensed nurses and available to Enrollees twenty- four (24) hours per day, seven (7) days a week. The nurse line shall provide health education and assist Enrollees in determining which place of care (e.g., urgent care center, emergency department, PCP office) is clinically appropriate for the symptoms described. Insurer shall also provide a behavioral health crisis line staffed by licensed professionals and available to Enrollees twenty-four (24) hours per day, seven (7) days a week. The behavioral health crisis line may be provided as part of the nurse line or separately. If the behavioral health crisis line is part of the nurse line, all licensed nurses must be trained appropriately. Insurer shall provide a publicly available website with access to Florida Healthy Kids information. The publicly available website shall include:

Enrollee Services. ‌ Insurer shall maintain an enrollee service unit to provide enrolleeEnrollee-related customer service. The enrollee service unit shall have the ability to answer Enrollee inquiries by telephone, electronic communication communication, and written communication. The enrollee service unit shall be accessible by a toll-free telephone number during the hours of 7:30 a.m. to 7:30 p.m. Eastern Time, Monday through Friday, except on stateFHKC-recognized holidays. Insurer shall utilize automatic call distribution equipment and enrollee services representatives staffing sufficient to handle the expected volume of calls. Insurer shall also provide a telecommunication device for the deaf (TTY/TDD) and access to interpreter services. Insurer shall ensure enrollee services representatives are satisfactorily trained and capable of resolving Enrollee and potential Enrollee inquiries in all areas related to Florida Healthy Kids. Insurer’s enrollee services representatives shall be familiar with the basic eligibility requirements for the Florida Healthy Kids Program, but shall refer or transfer individuals with detailed questions or concerns to the Florida KidCare call center. Insurer shall monitor the enrollee services line to ensure Insurer meets certain performance standards and for quality assurance, including recording calls, conducting routine audits audits, and other monitoring activities. Insurer shall meet the performance guarantees related to enrollee services included in Attachment C. Insurer shall provide a nurse line staffed by licensed nurses and available to Enrollees twenty- four (24) hours per day, seven (7) days a week. The nurse line shall provide health education and assist Enrollees in determining which place of care (e.g., urgent care center, emergency department, PCP office) is clinically appropriate for the symptoms described. Insurer shall also provide a behavioral health crisis line staffed by licensed professionals and available to Enrollees twenty-four (24) hours per day, seven (7) days a week. The behavioral health crisis line may be provided as part of the nurse line or separately. If the behavioral health crisis line is part of the nurse line, all licensed nurses must be trained appropriately. Insurer shall provide a publicly available website with access to Florida Healthy Kids information. The publicly available website shall include:: The Enrollee handbook, A printable provider directory, A searchable electronic provider directory, A link to FHKC’s Florida Healthy Kids website, and Any other information that may be needed by Enrollees or potential Enrollees. Insurer’s publicly available website is subject to FHKC approval. Insurer shall also provide a non-public website with secure access for Enrollees that shall include: The ability for Enrollees to print a temporary ID card, The ability for Enrollees to request a new ID card, and Enrollee educational materials (unless Insurer chooses to make such materials available on the publicly available website). Insurer’s non-public website is subject to FHKC’s approval.