Member Disenrollment for Cause. A member may request disenrollment from the MCO for cause at any time. For cause disenrollment requests must be submitted to SCHCC on the appropriate SCHCC form. The following are considered cause for disenrollment by the member: • The member moves out of the MCO’s service area; • The plan does not, because of moral or religious objections, cover the service the member seeks; • The member needs related services (for example, a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the network; and the member’s PCP or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk; and • Other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the member’s health care needs.
Member Disenrollment for Cause. A member in a CCN who is a mandatory enrollee and subject to the CCN “lock-in” period may initiate disenrollment or transfer after the first ninety (90) days of enrollment for cause only. The following are cause for disenrollment: • The member moves out of the CCN’s designated service area. • The CCN does not, because of moral or religious objections, cover the service the member seeks. • The member needs related services (for example a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the CCN; and the member's primary care provider or another provider determines that receiving the services separately would subject the member to unnecessary risk. • The Provider Agreement between the CCN and DHH is terminated. • The CCN has been sanctioned. • The member loses Medicaid/CHIP eligibility. • The member is placed in a nursing facility or intermediate care facility for people with developmental disabiliaties. • The member changes to an excluded group. • To implement the decision of a hearing officer in an appeal proceeding by the member against the CCN or as ordered by a court of law; and /or • Other reasons, including but not limited to: o Poor quality of care; o Lack of access to services covered under the Provider Agreement; o Lack of access to providers experienced in dealing with the enrollee's health care needs.
Member Disenrollment for Cause. A member may request disenrollment from the MCO for cause at any time. For cause disenrollment requests must be submitted to South Carolina Healthy Connections Choices (SCHCC), the SCDHHS’s Enrollment Broker, on the appropriate form. The following are considered cause for disenrollment by the member: • The member moves out of the MCO’s service area; • The plan does not, because of moral or religious objections, cover the service the member seeks; • The member needs related services (for example, a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the network; and the member’s PCP or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk; and • Other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the member’s health care needs.
