Common use of ENROLLMENT GENERALLY Clause in Contracts

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.

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 Health 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 will not discriminate against Potential Enrollees based on health status or need for healthcare services. 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 shall 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.

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.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.