EXCLUSIONS AND EXEMPTIONS. Persons who belong to one of the eligible populations (defined in 5.2A) shall not be subject to mandatory enrollment if they meet one or more criteria defined in this Article. Persons who fall into an "excluded" category (Article 5.3.1A) shall not be eligible to enroll in the contractor's plan. Persons falling into the categories under Article 5.
EXCLUSIONS AND EXEMPTIONS. V-2 5.3.1 ENROLLMENT EXCLUSIONS........................................V-3 5.3.2 ENROLLMENT EXEMPTIONS........................................V-4 5.4 ENROLLMENT OF MANAGED CARE ELIGIBLES.................................V-5 5.5 ENROLLMENT AND COVERAGE REQUIREMENTS.................................V-6 5.6 VERIFICATION OF ENROLLMENT..........................................V-10 5.7 MEMBER SERVICES UNIT................................................V-10 5.8 ENROLLEE EDUCATION AND INFORMATION..................................V-11 5.8.1 GENERAL REQUIREMENTS........................................V-11 5.8.2 ENROLLEE NOTIFICATION/HANDBOOK..............................V-12 5.8.3 ANNUAL INFORMATION TO ENROLLEES.............................V-18 5.8.4 NOTIFICATION OF CHANGES IN SERVICES.........................V-18 5.8.5 ID CARD.....................................................V-18 5.8.6 ORIENTATION AND WELCOME LETTER..............................V-19 5.9 PCP SELECTION AND ASSIGNMENT........................................V-19 5.9.1 INITIAL SELECTION/ASSIGNMENT................................V-20 5.9.2 PCP CHANGES.................................................V-20 5.10 DISENROLLMENT FROM CONTRACTOR'S PLAN................................V-22 5.10.1 GENERAL PROVISIONS..........................................V-22 5.10.2 DISENROLLMENT FROM THE CONTRACTOR'S PLAN AT THE ENROLLEE'S REQUEST......................................V-23 5.10.3 DISENROLLMENT FROM THE CONTRACTOR'S PLAN AT THE CONTRACTOR'S REQUEST....................................V-24 5.10.4 TERMINATION.................................................V-26 5.11 TELEPHONE ACCESS....................................................V-27 5.12 APPOINTMENT AVAILABILITY............................................V-28 5.13
EXCLUSIONS AND EXEMPTIONS. Recipient shall have no obligation of confidentiality with respect to any information which:
5.1. is already known or in the possession of Recipient or its Affiliate at the time of disclosure as shown by the Recipient’s and/or its Affiliates´ files and records prior to the time of disclosure, otherwise than as a result of any improper act or omission of Recipient or its Affiliate; or
5.2. is or becomes public knowledge through no wrongful act of Recipient; or
5.3. is rightfully acquired from others who did not obtain it under obligation of confidentiality; or
5.4. is independently developed by an employee, agent or consultant of Recipient without reference to the Confidential Information; or
5.5. is approved for release by written authorization from Disclosing Party.
5.6. The Recipient is hereby notified that, as set forth in 18 U.S.C. §1833(b), he/she does not have criminal or civil liability under U.S. trade secret law for the following disclosures of a trade secret:
5.6.1. disclosure in confidence to a federal, state or local government official, either directly or indirectly, or to an attorney, provided the disclosure is for the sole purpose of reporting or investigating a suspected violation of law; and/or
5.6.2. disclosure in a complaint or other document filed in a lawsuit or other proceeding if such filing is made under seal; and/or
5.6.3. under those circumstances where Recipient files a lawsuit for retaliation against the Disclosing Party for reporting a suspected violation of law, Recipient may disclose the Disclosing Party’s trade secret information to its attorney and may use the trade secret information in the court proceeding if Recipient files any document containing the trade secret under seal and does not disclose the trade secret, except pursuant to court order.
EXCLUSIONS AND EXEMPTIONS. Persons who belong to one of the eligible populations (defined in 5.2B) shall not be subject to mandatory enrollment if they meet one or more criteria defined in this Article. Persons who fall into an "excluded" category (Article 5.3.1A) shall not be eligible to enroll in the contractor's plan. Persons falling into the categories under Article 5.3.1B are eligible to enroll on a voluntary basis. Persons falling into a category under Article 5.3.2 may be eligible for enrollment exemption, subject to the Department's review.
EXCLUSIONS AND EXEMPTIONS. Recipient shall have no obligation of confidentiality with respect to any information which: is already known or in the possession of Recipient or its Affiliate at the time of disclosure as shown by the Recipient’s and/or its Affiliates´ files and records prior to the time of disclosure, otherwise than as a result of any improper act or omission of Recipient or its Affiliate; or is or becomes public knowledge through no wrongful act of Recipient; or is rightfully acquired from others who did not obtain it under obligation of confidentiality; or is independently developed by an employee, agent or consultant of Recipient without reference to the Confidential Information; or is approved for release by written authorization from Disclosing Party. The Recipient is hereby notified that, as set forth in 18 U.S.C. §1833(b), he/she does not have criminal or civil liability under U.S. trade secret law for the following disclosures of a trade secret: disclosure in confidence to a federal, state or local government official, either directly or indirectly, or to an attorney, provided the disclosure is for the sole purpose of reporting or investigating a suspected violation of law; and/or disclosure in a complaint or other document filed in a lawsuit or other proceeding if such filing is made under seal; and/or under those circumstances where Recipient files a lawsuit for retaliation against the Disclosing Party for reporting a suspected violation of law, Recipient may disclose the Disclosing Party’s trade secret information to its attorney and may use the trade secret information in the court proceeding if Recipient files any document containing the trade secret under seal and does not disclose the trade secret, except pursuant to court order.
EXCLUSIONS AND EXEMPTIONS. Notwithstanding section 2 above, this by-law shall not apply to:
EXCLUSIONS AND EXEMPTIONS. Persons who belong to one of the eligible populations (defined in 5.2A) shall not be subject to mandatory enrollment if they meet one or more criteria defined in this Article. Persons who fall into an “excluded” category (Article 5.3.1A) shall not be eligible to enroll in the contractor’s plan. Persons falling into the categories under Article 5.3.1B It is hereby understood and agreed by both parties that this contract shall be effective and payments by DMAHS made to the contractor suticct to the availability of State and federal funds. It is further agreed by both parties that this contract can be renegotiated or terminated, without liability to the State in order to comply with state and federal requirements for the purpose of maximizing federal financial participation.
EXCLUSIONS AND EXEMPTIONS. V-2 5.3.1
EXCLUSIONS AND EXEMPTIONS. Confidential Information shall not include: (a) information that is or becomes generally known to the public other than through breach of a duty of confidentiality Home Builder; or (b) information that Customer had in its possession at the time of disclosure and was not acquired from Home Builder or a third party that owed a duty of confidentiality to Home Builder as evidenced by Customer’s pre-existing written records. If Customer is required to disclose Confidential Information by virtue of a subpoena, other court order, or other legal requirement, Customer must first give Home Builder prompt written notice of the potential for such disclosure, Customer must limit the disclosure to the narrowest possible disclosure while still complying with the order, and must continue to protect the confidentiality of the Confidential Information. Notwithstanding anything to the contrary in this Agreement, the mere fact that some portion of the Confidential Information may be subject to protection under intellectual property or other laws does not exclude it from the scope of the definition of Confidential Information. Furthermore, the mere fact that some material that is currently within the scope of the definition of Confidential Information becomes known to the general public does not mean that it is not still subject to protection under other law or that other parts of the Confidential Information are no longer confidential.
EXCLUSIONS AND EXEMPTIONS. Persons who belong to one of the eligible populations (defined in 5.2A) shall not be subject to mandatory enrollment if they meet one or more criteria defined in this Article. Persons who fall into an "excluded" category (Article 5.
3.1 A) shall not be eligible to enroll in the contractor's plan. Persons falling into the categories under Article 5.
3. IB are eligible to enroll on a voluntary basis. Persons falling into a category under Article 5.3.2 may be eligible for enrollment exemption, subject to the Department's review.
1. Individuals whose Medicaid eligibility will terminate within three (3) months or less after the projected date of effective enrollment,
2. Individuals in mandatory eligibility categories who live in a county where mandatory enrollment is not yet required based on a phase-in schedule determined by DMAHS,
3. Individuals enrolled in or covered by either a Medicare or commercial HMO will not be enrolled in New Jersey Care 2000+ contractor unless the New Jersey Care 2000+ contractor and the Medicare/commercial HMO are the same.
4. Individuals in the Pharmacy Lock-in or Provider Warning or Hospice programs.
5. Individuals in eligibility categories other than AFDC/TANF, AFDC/TANF-related New Jersey Care, SSI-Aged, Blind and Disabled populations, the Division of Developmental Disabilities Community Care Waiver population, New Jersey Care -- Aged, Blind and Disabled, or NJ FamilyCare Plan A.
6. Children awaiting adoption through a private agency.
7. Individuals identified as having more than one active eligible Medicaid number.
8. DYFS Population,
