Information Requirements for Enrollees and Potential Enrollees Sample Clauses

Information Requirements for Enrollees and Potential Enrollees. The Contractor must provide to potential Enrollees and new Enrollees the information needed to understand benefit coverage and obtain care in accord with the provisions of this Section (42 C.F.R. § 438.10(b)(3) and 438.10(f)(3)). The information must be provided at least once a year, upon request and within fifteen (15) business days after the Contractor was notified of enrollment. The Contractor must notify Enrollees of their ability to request the information at any time. If the Enrollee or potential Enrollee is not able to understand written information, the Contractor will provide at no cost the necessary information in an alternative language or format that is understandable to the Enrollee or potential Enrollee.
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Information Requirements for Enrollees and Potential Enrollees. ‌ 3.2.1 HCA shall provide a managed care handbook to potential enrollees. The managed care handbook will provide sufficient, accurate written information to assist potential enrollees in making an informed decision about enrollment in accord with the provisions of this Section (SSA 1932(d)(2) and 42 C.F.R. § 438.10 and 438.104(b)(1)(iii)). The managed care handbook shall be translated or provided in an alternative format that is understandable to the potential enrollee 3.2.1.1 The Contractor may submit up to two pages of plan specific information to be included in the managed care handbook provided by HCA to potential enrollees. This will provide basic information about the Contractor’s program. 3.2.1.2 The Contractor may develop supplemental materials in addition to the managed care handbook that the Contractor sends to newly enrolled and assigned enrollees. Supplemental materials may not duplicate information, such as covered benefits, provided in the HCA-produced handbook, but may include contact numbers for Contractor’s customer service, information about the Contractor’s authorization processes, network providers and/or Value Added Benefits that the Contractor may provide. This supplemental, plan-specific material may be no longer than five (5) pages in length, and does not include mandatory materials such as NCQA-required materials and the annual notices that the Contractor is required to send to enrollees. 3.2.1.3 If the enrollee is not able to understand written information provided by the Contractor or only understands a language that is not translated, the Contractor shall provide the necessary information in an alternative format that is understandable to the enrollee. 3.2.2 As described above, HCA and the Contractor shall provide to potential enrollees and new enrollees the information needed to understand benefit coverage and obtain care in accord with the provisions of this Section (42 C.F.R. § 438.10(b)(3) and 438.10(f)(3)). The information shall be provided at least once a year, or upon request and within fifteen (15) working days of enrollment. The Contractor shall notify enrollees of their ability to request the information at any time. If the enrollee or potential enrollee is not able to understand written information or only understands a language that is not translated, the Contractor will provide the necessary information in an alternative format that is understandable to the enrollee or potential enrollee. 3.2.2.1 The Contractor shal...
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Information Requirements for Enrollees and Potential Enrollees. 3.2.1 The Contractor shall provide to potential enrollees and new enrollees sufficient, accurate information needed to understand benefit coverage and obtain care in accord with the provisions of this Section (42 C.F.R. § 438.10(b)(3) and 438.10(f)(3)). The information shall be provided at least once a year, or upon request and within fifteen (15) working days of enrollment. The Contractor shall coordinate with the enrollee or potential enrollee to provide the information in an alternative format that the enrollee can understand. 3.2.2 Information provided by the Contractor must include contact numbers for Contractor’s customer service, information about the Contractor’s authorization processes, network providers and/or Value Added Benefits that the Contractor may provide. 3.2.2.1 If the enrollee is not able to understand written information provided by the Contractor or only understands a language that is not translated, the Contractor shall provide the necessary information in an alternative format that is understandable to the enrollee. 3.2.3 The Contractor shall submit enrollee information developed by the Contractor that specifically mentions WMIP or the specific benefits provided under this Contract at least thirty (30) calendar days prior to distribution for review and approval. All other enrollee materials shall be submitted as informational. HCA may waive the thirty day requirement if, in HCA’s sole judgment, it is in the best interest of HCA and its clients to do so. 3.2.4 Changes to State or Federal law shall be reflected in information to enrollees no more than ninety (90) calendar days after the effective date of the change and enrollees shall be notified at least thirty (30) calendar days prior to the effective date if, in the sole judgment of HCA, the change is significant in regard to the enrollees’ quality of or access to care, which may include changes to: enrollment rights, grievance and hearing procedures, benefits, authorizations or coverage of emergency services. HCA shall notify the Contractor in writing of any significant change (42 C.F.R. § 438.6(i)(4) and 438.10(f)(4)). 3.2.5 The Contractor shall provide to enrollees and potential enrollees written information about: 3.2.5.1 Choosing a PCP, including general information on available PCPs and how to obtain specific information including a list of PCPs that includes their identity, location, languages spoken, qualifications, practice restrictions, and availability. 3.2.5.2 How to ch...
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Information Requirements for Enrollees and Potential Enrollees. 3.2.1 The Contractor shall provide sufficient, accurate oral and written information to potential enrollees to assist them in making an informed decision about enrollment in accord with Section 3.2.5 (SSA 1932(d)(2) and 42 CFR 438.10). 3.2.2 The Contractor shall provide to potential enrollees upon request and to each enrollee, within fifteen (15) working days of enrollment, at any time upon request, and at least once a year, the information needed to understand benefit coverage and obtain care in accord with Section 3.2.5. 3.2.3 Prior to distribution, all enrollee information shall be submitted to HCA and DSHS for written approval. 3.2.4 Changes to State or Federal law shall be reflected in information to enrollees no more than ninety (90) calendar days after the effective date of the change and enrollees shall be notified at least thirty (30) calendar days prior to the effective date if, in the sole judgment of DSHS, the change is significant in regard to the enrollees’ quality of or access to care. HCA or DSHS shall notify the Contractor of any significant change in writing. 3.2.5 The Contractor’s written information to enrollees and potential enrollees shall include: 3.2.5.1 How to choose a PCP, including general information on available PCPs and how to obtain specific information including a list of PCPs that includes their identity, location, languages spoken, qualifications, practice restrictions, and availability. 3.2.5.2 How to change a PCP. 3.2.5.3 How to access services outside the Contractor’s service area.
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Information Requirements for Enrollees and Potential Enrollees. The Contractor shall provide to new Enrollees the information needed to understand benefit coverage and obtain care in accordance with the provisions of this Section. Specifically, the Contractor shall provide information to Enrollees on the GFS services, including how to access them. The information shall be provided at least once a year upon request and within fifteen (15) working days of enrollment. In providing this information to the Enrollees, the Contractor may use an existing member handbook that is otherwise provided to Enrollees; however, such handbook must be prior approved in writing by the HCA. The Contractor shall submit branding materials developed by the Contractor that specifically mention GFS services for review and approval. No such materials shall be disseminated to Enrollees, providers or other members of the public without HCA’s approval. The Contractor shall submit Enrollee information developed by the Contractor that specifically mentions GFS services provided under this Contract at least thirty (30) calendar days prior to distribution for review and approval. All other Enrollee materials shall be submitted as informational. HCA may waive the thirty (30) day requirement if, in HCA’s sole judgment, it is in the best interest of HCA and its clients to do so.
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Information Requirements for Enrollees and Potential Enrollees. 3.2.1 The Contractor shall provide sufficient, accurate oral and written information to potential enrollees to assist them in making an informed decision about enrollment (SSA 1932(d)(2) and 42 CFR 438.10). 3.2.2 The Contractor shall provide to potential enrollees upon request and to each enrollee, within fifteen (15) working days of enrollment, at any time upon request, and at least once a year, the information needed to understand benefit coverage and obtain care. 3.2.3 All enrollee information shall have the prior written approval of DSHS. 3.2.4 Changes to State or Federal law shall be reflected in information to enrollees no more than ninety (90) calendar days after the effective date of the change and enrollees shall be notified at least thirty (30) calendar days prior to the effective date if, in the sole judgment of DSHS, the change is significant in regard to the enrollees’ quality of or access to care. DSHS shall notify the Contractor of any significant change in writing. 3.2.5 The Contractor’s written information to enrollees and potential enrollees shall include: 3.2.5.1 How to choose a PCP, including general information on available PCPs and how to obtain specific information including a list of PCPs that includes their identity, location, languages spoken, qualifications, practice restrictions, and availability. 3.2.5.2 How to change a PCP. 3.2.5.3 How to access services outside the Contractor’s service area. 3.2.5.4 How to access Emergency Services. 3.2.5.5 General information about accessing hospital care and how to get a list of hospitals that are available to enrollees. 3.2.5.6 General information regarding specialists available to enrollees and how to obtain specific information including a list of specialists that includes their identity, location, languages spoken, qualifications, practice restrictions, and availability. 3.2.5.7 How to obtain information regarding any limitations to the availability of or referral to specialists to assist the enrollee in selecting a PCP. 3.2.5.8 How to obtain information regarding Physician Incentive Plans (42 CFR 422.208 and 422.210), and information on the Contractor’s structure and operations. 3.2.5.9 Informed consent guidelines.
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Related to Information Requirements for Enrollees and Potential Enrollees

  • Contracting Information Requirements Contractor represents and warrants that it will comply with the requirements of Section 552.372(a) of the Texas Government Code. Except as provided by Section 552.374(c) of the Texas Government Code, the requirements of Subchapter J (Additional Provisions Related to Contracting Information), Chapter 552 of the Government Code, may apply to the Contract and the Contractor agrees that the Contract can be terminated if the Contractor knowingly or intentionally fails to comply with a requirement of that subchapter.

  • Presentation of Potential Target Businesses The Company shall cause each of the Initial Shareholders to agree that, in order to minimize potential conflicts of interest which may arise from multiple affiliations, the Initial Shareholders will present to the Company for its consideration, prior to presentation to any other person or company, any suitable opportunity to acquire an operating business, until the earlier of the consummation by the Company of a Business Combination or the liquidation of the Company, subject to any pre-existing fiduciary obligations the Initial Shareholders might have.

  • Information Requirements The Company covenants that, if at any time before the end of the Effectiveness Period the Company is not subject to the reporting requirements of the Exchange Act, it will cooperate with any Holder and take such further reasonable action as any Holder may reasonably request in writing (including, without limitation, making such reasonable representations as any such Holder may reasonably request), all to the extent required from time to time to enable such Holder to sell Registrable Securities without registration under the Securities Act within the limitation of the exemptions provided by Rule 144 and Rule 144A under the Securities Act and customarily taken in connection with sales pursuant to such exemptions. Upon the written request of any Holder, the Company shall deliver to such Holder a written statement as to whether it has complied with such filing requirements, unless such a statement has been included in the Company’s most recent report filed pursuant to Section 13 or Section 15(d) of Exchange Act. Notwithstanding the foregoing, nothing in this Section 7 shall be deemed to require the Company to register any of its securities (other than the Common Stock) under any section of the Exchange Act.

  • Information Requirement The successful bidder's shall be required to advise the Office of Management and Budget, Government Support Services of the gross amount of purchases made as a result of the contract.

  • Electronic and Information Resources Accessibility and Security Standards a. Applicability: The following Electronic and Information Resources (“EIR”) requirements apply to the Contract because the Grantee performs services that include EIR that the System Agency's employees are required or permitted to access or members of the public are required or permitted to access. This Section does not apply to incidental uses of EIR in the performance of the Agreement, unless the Parties agree that the EIR will become property of the State of Texas or will be used by HHSC’s clients or recipients after completion of the Agreement. Nothing in this section is intended to prescribe the use of particular designs or technologies or to prevent the use of alternative technologies, provided they result in substantially equivalent or greater access to and use of a Product.

  • Credentialing Requirements Registry Operator, through the facilitation of the CZDA Provider, will request each user to provide it with information sufficient to correctly identify and locate the user. Such user information will include, without limitation, company name, contact name, address, telephone number, facsimile number, email address and IP address.

  • EDD Independent Subrecipient Reporting Requirements Effective January 1, 2001, the County of Orange is required to file in accordance with subdivision (a) of Section 6041A of the Internal Revenue Code for services received from a “service provider” to whom the County pays $600 or more or with whom the County enters into a contract for $600 or more within a single calendar year. The purpose of this reporting requirement is to increase child support collection by helping to locate parents who are delinquent in their child support obligations. The term “service provider” is defined in California Unemployment Insurance Code Section 1088.8, Subparagraph B.2 as “an individual who is not an employee of the service recipient for California purposes and who received compensation or executes a contract for services performed for that service recipient within or without the State.” The term is further defined by the California Employment Development Department to refer specifically to independent Subrecipients. An independent Subrecipient is defined as “an individual who is not an employee of the ... government entity for California purposes and who receives compensation or executes a contract for services performed for that ... government entity either in or outside of California.” The reporting requirement does not apply to corporations, general partnerships, limited liability partnerships, and limited liability companies. Additional information on this reporting requirement can be found at the California Employment Development Department web site located at xxxx://xxx.xxx.xx.xxx/Employer_Services.htm

  • Certification Regarding Business with Certain Countries and Organizations Pursuant to Subchapter F, Chapter 2252, Texas Government Code, PROVIDER certifies it is not engaged in business with Iran, Sudan, or a foreign terrorist organization. PROVIDER acknowledges this Purchase Order may be terminated if this certification is or becomes inaccurate.

  • Training Requirements Grantee shall: A. Authorize and require staff (including volunteers) to attend training, conferences, and meetings as directed by DSHS; B. Appropriately budget funds in order to meet training requirements in a timely manner, and ensure that staff and volunteers are trained as specified in the training requirements listed at xxxxx://xxx.xxxx.xxxxx.xxx/hivstd/training/ and as otherwise specified by DSHS. Grantee shall document that these training requirements are met; and C. Ensure that staff hired for HIV and syphilis testing are trained to perform blood draws within three (3) months of employment.

  • Food Service Waste Reduction Requirements Contractor shall comply with the Food Service Waste Reduction Ordinance, as set forth in San Francisco Environment Code Chapter 16, including but not limited to the remedies for noncompliance provided therein.

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