ENROLLMENT GENERALLY Sample Clauses

ENROLLMENT GENERALLY. All Potential Enrollees who live in the Contracting Area shall be required to become an Enrollee in a plan participating in the Integrated Care Program, except those Potential Enrollees who, pursuant to federal law, are subject only to voluntary enrollment. The Illinois Client Enrollment Broker (ICEB) shall be responsible for the enrollment of Potential Enrollees, including the provision of all health care plan choice education, enrollment by active choice, and enrollment by auto-assignment. Contractor shall continue to accept Potential Enrollees for enrollment until the Department determines that any further enrollments would exceed Contractor’s capacity based on a review conducted pursuant to Section 5.5.3. Contractor shall accept each Potential Enrollee whose name appears on the 834 Audit File and 834 Daily File. Enrollment shall be without restriction and shall be in the order in which Potential Enrollees apply or are assigned. Contractor shall not participate in facilitating enrollment, including during the Open Enrollment Period. Contractor may educate a Potential Enrollee regarding the specific elements of Contractor, provided that Contractor engages in no Marketing activities prohibited under Section 4.16. Contractor shall refer all requests for enrollment to the ICEB, which shall not be considered “facilitating enrollment”. Nothing in this Contract shall be deemed to be a guarantee of any Potential Enrollee’s enrollment with Contractor.
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ENROLLMENT GENERALLY. 4.1.1 All Potential Enrollees who live in the Contracting Area shall be required to become Enrollees in a Health Plan, except those Potential Enrollees who, pursuant to federal law or a waiver approved by Federal CMS, are subject only to voluntary enrollment or are part of an excluded population. The ICES shall be responsible for the enrollment of Potential Enrollees, including the provision of all education regarding healthcare plan choices, enrollment by active choice, and enrollment by automatic assignment. Contractor shall continue to accept Potential Enrollees for enrollment until the Department determines that any further enrollments would exceed Contractor’s capacity based on a review conducted pursuant to section 4.15. Contractor shall accept each Potential Enrollee whose name appears on the 834 Audit File and 834 Daily File. Enrollment shall be without restriction and shall be in the order in which Potential Enrollees apply or are assigned. Contractor shall not participate in facilitating enrollment, including during the Open Enrollment Period. Contractor may educate a Potential Enrollee regarding the specific elements of Contractor, provided that Contractor engages in no Marketing activities prohibited under section 4.17. Contractor shall refer all requests for enrollment to the ICES, which shall not be considered “facilitating enrollment.” Nothing in this Contract shall be deemed to be a guarantee of any Potential Enrollee’s enrollment with Contractor. 4.1.2 For new Enrollees transferring from another MCO, the Department will notify Contractor of the Enrollee’s previous MCO, and Contractor will immediately request the Enrollee’s IPoC from that MCO. 4.1.3 For past Enrollees who have left Contractor’s Health Plan, Contractor shall provide an Enrollee’s IPoC within ten (10) Business Days after receiving a request for it from the MCO in which the individual is enrolled.
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ENROLLMENT GENERALLY. 4.1.1.1 For enrollments of DCFS Youth in Care effective on the Comprehensive Implementation Date, the Department shall assign the DCFS Youth in Care into Contractor’s DCFS Youth Managed Care Specialty Plan. The DCFS Guardianship Administrator will have a ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1. 4.1.1.2 For enrollments of Former Youth in Care effective on the Comprehensive Implementation Date, the Department shall assign the Former Youth in Care to Contractor. The Department will mail the Prospective Enrollee notice of the enrollment assignment at least thirty (30) days prior to the Effective Enrollment Date. The notice will include the provision of all education regarding Health Plan choices, and the ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1. 4.1.1.3 For enrollments of DCFS Youth in Care effective after the Comprehensive Implementation Date, the DCFS Guardianship Administrator shall select a Health Plan for the Prospective Enrollee. The Department will process the Health Plan enrollment received from the DCFS Guardianship Administrator. All Enrollees will have a ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1. All Enrollees will have the opportunity to retain their current Medicaid Providers, including HealthWorks Providers, as long as that Medicaid Provider is within the selected Health Plan’s network. 4.1.1.4 At the time a DCFS Youth in Care Enrollee becomes a Former Youth in Care, the Enrollee will remain enrolled with Contractor. The ICES will mail an enrollment notice to the Enrollee within five (5) Business Days of the Enrollee becoming a Former Youth in Care. The mailed enrollment notice will include the notice of continued Health Plan assignment and the provision of all education regarding Health Plan choices, and the ninety (90)-day change period after the Effective Enrollment Date to select another Health Plan as provided in Section 4.10.1.
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ENROLLMENT GENERALLY. Any Potential Enrollee who resides, at the time of Enrollment, in the Contracting Area shall be eligible to become an Enrollee except as described in Article IX, Section 9.12. Enrollment shall be voluntary, except as provided in Article IV, Section 4.1
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ENROLLMENT GENERALLY. Any Potential Enrollee who resides, at the time of enrollment, in the Contracting Area shall be eligible to become an Enrollee. Enrollment shall be voluntary. Except as provided herein, enrollment shall be open during the entire period of this Contract until the enrollment limit of the Contractor, as set forth in Attachment I, is reached. The Contractor must continue to accept enrollment until such enrollment limit is reached. Such enrollment shall be without restriction and in the order in which Potential Enrollees apply. The Contractor shall not discriminate against Potential Enrollees on the basis of such individuals’ health status or need for health services. Similarly, Contractor will not discriminate against Potential Enrollees on the basis of race, color, or national origin, and will not use any policy or practice that has the effect of discriminating on the basis of race, color, or national origin. The Contractor shall accept each Enrollee whose name appears on the 834 Audit File.
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ENROLLMENT GENERALLY. Any Eligible Enrollee who resides, a the time of Enrollment, in the Contracting Area shall be eligible to become a Beneficiary except as described in Article IX, Section
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ENROLLMENT GENERALLY. (A) The Contractor shall have a continuous open enrollment period for new Enrollees. Enrollment is open to any qualified Medicaid Eligible Individual who meets the eligibility requirements for enrollment. The Department shall certify, and the Contractor agrees to accept, individuals who are eligible to be enrolled in the Health Plan. Contractor shall accept Enrollees in the order in which they apply. (B) New Enrollees shall be selected based upon the eligibility requirement that the Medicaid Eligible Individual has a development disability that is medically complex with major developmental challenges due to mental illness or behavioral problems. (C) Enrollees may be made retroactively eligible up to 6 months.
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Related to ENROLLMENT GENERALLY

  • Enrollment The Competitive Supplier shall be responsible for enrolling all Eligible Consumers through EDI transactions submitted to the LDC for all enrollments of Eligible Consumers during the term of this Agreement.

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department will advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor will be bound by the changes in enrollment procedures.

  • Enrollment Period Educational Support Professionals may elect to participate in the Career Transition Trust annually during a two (2) week enrollment period determined by the District, but that will occur no later than May 1st each year, provided they have met the eligibility requirements for participation in Subdivision. 2.

  • Open Enrollment Period Open Enrollment is a period of time each year when you and your eligible dependents, if family coverage is offered, may enroll for healthcare coverage or make changes to your existing healthcare coverage. The effective date will be on the first day of your employer’s plan year. A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health coverage. You and your eligible dependents may enroll for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days of the following events: • you get married, the coverage effective is the first day of the month following your marriage. • you have a child born to the family, the coverage effective date is the date of birth. • you have a child placed for adoption with your family, the coverage effective date is the date of placement. Special note about enrolling your newborn child: You must notify your employer of the birth of a newborn child and pay the required premium within thirty -one (31) days of the date of birth. Otherwise, the newborn will not be covered beyond the thirty -one (31) day period. This plan does not cover services for a newborn child who remains hospitalized after thirty-one (31) days and has not been enrolled in this plan. If you are enrolled in an Individual Plan when your child is born, the coverage for thirty- one (31) days described above means your plan becomes a Family Plan for as long as your child is covered. Applicable Family Plan deductibles and maximum out-of-pocket expenses may apply. In addition, if you lose coverage from another plan, you may enroll or add your eligible dependents for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days following the date you lost coverage. Coverage will begin on the first day of the month following the date your coverage under the other plan ended. In order to be eligible, the loss of coverage must be the result of: • legal separation or divorce; • death of the covered policy holder; • termination of employment or reduction in the number of hours of employment; • the covered policy holder becomes entitled to Medicare; • loss of dependent child status under the plan; • employer contributions to such coverage are being terminated; • COBRA benefits are exhausted; or • your employer is undergoing Chapter 11 proceedings. You are also eligible for a Special Enrollment Period if you and/or your eligible dependent lose eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), or if you and/or your eligible dependent become eligible for premium assistance for Medicaid or a (CHIP). In order to enroll, you must provide required information within sixty (60) days following the change in eligibility. Coverage will begin on the first day of the month following our receipt of your application. In addition, you may be eligible for a Special Enrollment Period if you provide required information within thirty (30) days of one of the following events: • you or your dependent lose minimum essential coverage (unless that loss of coverage is due to non-payment of premium or your voluntary termination of coverage); • you adequately demonstrate to us that another health plan substantially violated a material provision of its contract with you; • you make a permanent move to Rhode Island: or • your enrollment or non-enrollment in a qualified health plan is unintentional, inadvertent, or erroneous and is the result of error, misrepresentation, or inaction by us or an agent of HSRI or the U.S. Department of Health and Human Services (HHS).

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.

  • Special Enrollment a. KFHPWA will allow special enrollment for persons: 1) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and have had such other coverage terminated due to one of the following events: • Cessation of employer contributions. • Exhaustion of COBRA continuation coverage. • Loss of eligibility, except for loss of eligibility for cause. 2) Who initially declined enrollment when otherwise eligible because such persons had other health care coverage and who have had such other coverage exhausted because such person reached a lifetime maximum limit. KFHPWA or the Group may require confirmation that when initially offered coverage such persons submitted a written statement declining because of other coverage. Application for coverage must be made within 31 days of the termination of previous coverage. b. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents (other than for nonpayment or fraud) in the event one of the following occurs: 1) Divorce or Legal Separation. Application for coverage must be made within 60 days of the divorce/separation. 2) Cessation of Dependent status (reaches maximum age). Application for coverage must be made within 30 days of the cessation of Dependent status. 3) Death of an employee under whose coverage they were a Dependent. Application for coverage must be made within 30 days of the death of an employee. 4) Termination or reduction in the number of hours worked. Application for coverage must be made within 30 days of the termination or reduction in number of hours worked. 5) Leaving the service area of a former plan. Application for coverage must be made within 30 days of leaving the service area of a former plan. 6) Discontinuation of a former plan. Application for coverage must be made within 30 days of the discontinuation of a former plan. c. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their Dependents in the event one of the following occurs: 1) Marriage. Application for coverage must be made within 31 days of the date of marriage. 2) Birth. Application for coverage for the Subscriber and Dependents other than the newborn child must be made within 60 days of the date of birth. 3) Adoption or placement for adoption. Application for coverage for the Subscriber and Dependents other than the adopted child must be made within 60 days of the adoption or placement for adoption. 4) Eligibility for premium assistance from Medicaid or a state Children’s Health Insurance Program (CHIP), provided such person is otherwise eligible for coverage under this EOC. The request for special enrollment must be made within 60 days of eligibility for such premium assistance. 5) Coverage under a Medicaid or CHIP plan is terminated as a result of loss of eligibility for such coverage. Application for coverage must be made within 60 days of the date of termination under Medicaid or CHIP. 6) Applicable federal or state law or regulation otherwise provides for special enrollment.

  • Deferral Election A Participant may elect to defer all or a specified percentage of the Compensation earned in a Plan Year by such Participant for serving as a member of the Board of any Participating Fund or as a member of any committee or subcommittee thereof. Reimbursement of expenses of attending meetings of the Board, committees of the Board or subcommittees of such committees may not be deferred. Such election shall be made by executing before the first day of such Plan Year such election notice as the Administrator may prescribe; provided, however, that upon first becoming eligible to participate in the Plan by reason of appointment to a Board, a Participant may file a Deferral Election not later than 30 days after the effective date of such appointment, which election shall apply to Compensation earned in the portion of the Plan Year commencing the day after such election is filed and ending on the last day of such Plan Year.

  • Open Enrollment KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as described above during a limited period of time specified by the Group and KFHPWA.

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Shift Selection Employee assignments within the Patrol Bureau will occur between approximately April 1-15 and shall be awarded based upon seniority. Approximately three (3) months before then the Department will publish a call for written requests on shift assignment. Employees will make their first three (3) choices known. Employees will learn of the assignment, including days off associated with their assignment, immediately after the bidding process is completed. Assignments will take effect on the schedule immediately following July 1st. Residence Hall assignments will be made prior to all others. No officer will be required to work a Residence Hall assignment in consecutive years. Assignment of the remaining officers will begin with selection(s) for day and night shifts. The bid for assignments will continue until all positions are filled. The following general rules apply to assignments: 1. During the term of this Agreement, no employee will be reassigned to a different shift other than the shift awarded by seniority except in situations where the University cannot continue to provide police services. In the event a shift reassignment must occur, it will be offered to volunteers based on seniority. If there are no volunteers it will be assigned to the least senior officer in the department. 2. Shift selection shall be an appropriate subject for the Joint Labor/Management Committee. 3. If a shift becomes available as a result of trainees being released for duty, and if there is at least four (4) months until the next shift change, the shift will be posted and awarded by seniority. The new trainee released for duty will take the senior officers shift. If no employee desires the shift, the trainee scheduled for assignment will be assigned that shift. The parties recognize that for the betterment of the Department it may be necessary to assign a trainee to a specific shift. 4. Voluntary shift trades will be allowed as long as overtime costs are not incurred. 5. Except in a bona fide emergency, no employee shall be assigned to work more than sixteen (16) hours in a twenty-four (24) hour period, provided however employees may volunteer to work up to eighteen (18) hours in a twenty-four (24) hour period.

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