Information Provided for Enrollment Process Sample Clauses

Information Provided for Enrollment Process. The Contractor shall provide each member with clear, accurate and truthful information about the Contractor's health plan to ensure compliance with this Contract and with state and federal laws and regulations. The Contractor shall be responsible for developing and distributing its own member specific marketing, educational and enrollment materials including but not limited to, evidence of coverage and other materials designed for member education. All written material shall be written at a grade level no higher than the fourth (4th) grade, or as determined appropriate by SCDHHS. The Contractor shall not cause or knowingly permit the use of advertising which is untrue, misleading or deceptive. The information must include a statement that enrollment in the Contractor's Plan by a Medicaid applicant/eligible shall be voluntary. The Contractor shall inform the members that enrollment shall be for a period of twelve (12) months contingent upon their continued Medicaid eligibility and that the member may request disenrollment without cause at any time during the 90 days following the date of the member’s initial enrollment with the MHN.
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Information Provided for Enrollment Process. The Contractor shall provide each member with clear, accurate and truthful information about the Contractor's health plan to ensure compliance with this Contract and with state and federal laws and regulations. The Contractor shall be responsible for developing and distributing its own member specific marketing, educational and enrollment materials including but not limited to, evidence of coverage and other materials designed for member education. All written material shall be written at a grade level no higher than the fourth (4th) grade, or as determined appropriate by SCDHHS. The Contractor shall not cause or knowingly permit the use of advertising which is untrue, misleading or deceptive. The information must include a statement that enrollment in the Contractor's Plan by a Medicaid applicant/eligible shall be voluntary. The Contractor shall inform the members that enrollment shall be for a period of twelve (12) months contingent upon their continued Medicaid eligibility and that the member may request disenrollment once, without cause, at any time during the ninety (90) calendar days following the date of the member’s initial enrollment with the MHN.
Sample 1
Information Provided for Enrollment Process. The Contractor shall provide each Medicaid MCO Member with clear, accurate and truthful information about the Contractor's health plan to ensure compliance with this Contract and state and federal laws and regulations. The Contractor shall ascertain whether the Medicaid MCO Member has a PCP and if so, whether that PCP is a member of the Contractor’s Provider network. The Contractor shall be responsible for developing and distributing its own Medicaid MCO Member specific marketing, educational and enrollment materials including, but not limited to, evidence of coverage, Medicaid MCO Member handbook, and other materials designed for Medicaid MCO Member education and MCO enrollment form. All written material shall be written at a grade level no higher than the fourth (4th) grade, or as determined appropriate by the Department. The Contractor shall not cause or knowingly permit the use of advertising which is untrue, misleading or deceptive. The information must include a statement that enrollment in the Contractor's health plan by a Medicaid Eligible shall be voluntary. The Contractor shall inform the Medicaid MCO Members that enrollment shall be for a period of twelve
Sample 1
Information Provided for Enrollment Process. The Contractor shall provide each member with clear, accurate and truthful information about the Contractor's health plan to ensure compliance with this Contract and with state and federal laws and regulations. The Contractor shall ascertain whether the beneficiary has a Primary Care Physician and if so, whether their PCP is a member of the MCO network. The Contractor shall be responsible for developing and distributing its own member specific marketing, educational and enrollment materials including but not limited to, evidence of coverage, member handbook, other materials designed for member education and MCO enrollment form. All written material shall be written at a grade level no higher than the fourth (4th) grade, or as determined appropriate by SCDHHS. The Contractor shall not cause or knowingly permit the use of advertising which is untrue, misleading or deceptive. The information must include a statement that enrollment in the Contractor's Plan by a Medicaid applicant/eligible shall be voluntary. The Contractor shall inform the members that enrollment shall be for a period of twelve (12) months contingent upon their continued Medicaid eligibility and that the member may request disenrollment once, without cause at any time during the 90 days following the date of the member’s initial enrollment with the MCO. During marketing presentations, the Contractor must ask female recipients the name of the OB/GYN doctor they are currently using. The Contractor must inform the recipient whether the doctor is a member of the Contractor’s provider network. If the doctor is not a member of the Contractor’s provider network, the recipient must be provided the Contractor’s current provider listing from which she can choose a doctor.
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Related to Information Provided for Enrollment Process

  • Office of Inspector General Investigative Findings Expert Review In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 531.102(m-1)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Evaluation of Students Acknowledging the District’s adopted grading system, the teacher shall maintain the right and responsibility to determine grades and other evaluation of a student. No grade or evaluation shall be changed except by the teacher with the approval of the building administrator.

  • DISQUALIFICATION FOR PAST PERFORMANCE AND FINDINGS OF NON RESPONSIBILITY Bidder may be disqualified from receiving awards if Bidder, or anyone in Bidder’s employment, has previously failed to perform satisfactorily in connection with public Bidding or contracts or is deemed non- responsible.

  • Certification of Meeting or Exceeding Tobacco-Free Workplace Policy Minimum Standards A. Grantee certifies that it has adopted and enforces a Tobacco-Free Workplace Policy that meets or exceeds all of the following minimum standards of:

  • Proposing Integration Activities in the Planning Submission No integration activity described in section 6.3 may be proposed in a CAPS unless the LHIN has consented, in writing, to its inclusion pursuant to the process set out in section 6.3(b).

  • 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.

  • How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.

  • DATA USED FOR CALCULATIONS The calculations for payments under this Agreement shall be initially based upon the valuations that are placed upon all taxable property in the District, including the Applicant’s Qualified Property, by the Appraisal District in its annual certified tax roll submitted to the District for each Tax Year pursuant to TEXAS TAX CODE § 26.01 on or about July 25 of each year of this Agreement. Immediately upon receipt of the valuation information by the District, the District shall submit the valuation information to the Third Party selected and appointed under Section 4.3. The certified tax roll data shall form the basis of the calculation of any and all amounts due under this Agreement. All other data utilized by the Third Party to make the calculations contemplated by this Agreement shall be based upon the best available current estimates. The data utilized by the Third Party shall be adjusted from time to time by the Third Party to reflect actual amounts, subsequent adjustments by the Appraisal District to the District’s certified tax roll or any other changes in student counts, tax collections, or other data.

  • Enrollment Procedures The District shall establish an open enrollment period each year for unit members to participate in the Catastrophic Leave Bank. The enrollment period shall be September 1 through December 1. Once a unit member becomes a participant in the Catastrophic Leave Bank, he/she shall not be required to reenroll each year.

  • Standard of Review The Parties acknowledge and agree that the standard of review for any avoidance, breach, rejection, termination or other cessation of performance of or changes to any portion of this integrated, non-severable Agreement (as described in Section 22) over which FERC has jurisdiction, whether proposed by Seller, by Buyer, by a non-party of, by FERC acting sua sponte shall be the “public interest” standard of review set forth in United Gas Pipe Line Co. v.

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