Member Enrollment. Indiana Health Coverage Program applicants have an opportunity to select an MCE on their application. MCEs are expected to conduct marketing and outreach efforts to raise awareness of the Hoosier Healthwise program and their product. The Enrollment Broker is available to assist members in choosing an MCE. Applicants who do not select an MCE on their application will be auto-assigned to an MCE according to the State’s auto- assignment methodology. The State reserves the right to amend the auto-assignment logic and may incorporate HEDIS or other quality indicators into the auto-assignment logic at a future date. Default auto-assignment will not be available to any MCE who does not successfully complete readiness review. In accordance with 42 CFR 438.10(e), the State shall provide to potential members general information about the basic features of managed care and information specific to each MCE operating in the potential member’s service area. At minimum, this information will include factors such as Contractor service area, benefits covered, cost- sharing and network provider information. The State shall provide information on program MCEs in a comparative chart-like format. Once available, the State also intends to include Contractor quality and performance indicators on materials distributed to facilitate MCE selection. The State reserves the right to develop a rating system advertising Contractor performance on areas such as consumer satisfaction, network access and quality improvement. To facilitate State development of these materials, the Contractor shall comply with State requests for information needed to develop informational materials for potential members. Per 42 CFR 438.3(d), the Contractor shall accept individuals eligible for enrollment in the order in which they apply without restriction. The Contractor shall not, on the basis of health status or need for health care services, discriminate against individuals eligible to enroll. Additionally, the Contractor shall not discriminate against individuals eligible to enroll on the basis of race, color, national origin, sex, sexual orientation, gender identity or disability and will not use any policy or practice that has the effect of discriminating in such manner. Contractor shall also adhere to Section 1557 of the Affordable Care Act / 45 CFR 92.1.
Member Enrollment. The Department is solely responsible for the Enrollment of Medicaid Beneficiaries and Managed Care Members into the Healthy Connections Program. The Department will use its best efforts to ensure that the CONTRACTOR receives timely and accurate Enrollment and Disenrollment information. In the event of discrepancies or unresolvable differences between the Department and the CONTRACTOR regarding Enrollment, Disenrollment and/or termination, the Department will be responsible for taking the appropriate action for resolution.
Member Enrollment. The host site understands that the Program will reduce or renegotiate the awarded member slots at any time if the host site is unable to fill the host site’s AmeriCorps slots.
Member Enrollment. Indiana Health Coverage Program applicants have an opportunity to select an MCE on their application. MCEs are expected to conduct marketing and outreach efforts to raise awareness of both the program and their product. The Enrollment Broker is available to assist members in choosing an MCE. Applicants who do not select an MCE on their application will be auto- assigned to an MCE according to the State’s auto-assignment methodology. The State reserves the right to amend the auto-assignment logic and may incorporate HEDIS or other quality indicators into the auto-assignment logic at a future date. Default auto-assignment will not be available to any MCE who does not successfully complete readiness review In accordance with 42 CFR 438.10(e), the State shall provide to potential members general information about the basic features of managed care and information specific to each MCE operating in the potential member’s service area. At minimum, this information will include factors such as Contractor service area, benefits covered, cost- sharing and network provider information. The State shall provide information on program MCEs in a comparative chart-like format. Once available, the State also intends to include Contractor quality and performance indicators on materials distributed to facilitate MCE selection. The State reserves the right to develop a rating system advertising Contractor performance on areas such as consumer satisfaction, network access and quality improvement. To facilitate State development of these materials, the Contractor shall comply with State requests for information needed to develop informational materials for potential members.
Member Enrollment. Velovita provides to its Member (i) a personalized marketing website that includes web hosting and (ii) the V-Cloud administrative tools that enable the Member to manage his/ her business, view online tools, review the calculation and payment of commissions, and access previous records of Member purchases. When a Member elects to enroll with the Velovita V-Cloud at an annual cost of forty- nine dollars and ninety-five cents ($49.95 USD), such Member will have unlimited access to his/her V-Cloud management software for one year from the date of purchase. This amount will be refunded only if the Member resigns within the first 30 (thirty) days after the registration purchase.
Member Enrollment. (A) Maximum Medicaid Enrollment HSD and the CONTRACTOR may mutually agree in writing to establish a maximum Medicaid enrollment level for Members, which may vary throughout the term of this Agreement. The maximum Medicaid enrollment also may be established by HSD on a statewide or county-by-county basis based on the capacity of the CONTRACTOR’s provider network, or to ensure that the CONTRACTOR has the capacity to provide statewide Covered Services to its Members. Subsequent to the establishment of this limit, if the CONTRACTOR wishes to change its maximum enrollment level, the CONTRACTOR shall notify HSD in writing ninety (90) calendar days prior to the desired effective date of the proposed change. HSD shall approve all requests for changing maximum enrollment levels before implementation. Should a maximum enrollment level be reduced to below the actual enrollment level, HSD may disenroll Members to establish compliance with the new limit. HSD may reduce the maximum enrollment levels for reasons such as imposing a sanction for not having sufficient Network Providers to guarantee access, violating marketing regulations, or for a material breach of this Agreement.
Member Enrollment. Members will be eligible to enroll in the Everside Health Center upon the receipt by Everside of an Eligibility File from Client. During the Term of this Agreement and subject to Everside Health Center policies, an enrolled Member will remain enrolled in the Everside Health Center until Everside receives from Client notice that a Member has disenrolled for any reason and an Eligibility File that does not include such Member’s information. Client shall submit to Everside a current census of covered lives by the 7th calendar day of each month, listing those Members as of the 1st calendar day of the same month. Everside Responsibilities.
Member Enrollment. Homes for All begins enrollment on August 1st of each year. All enrollment paperwork must be completed and signed before the member’s start date for them to begin service on that start date, provided that the National Service Criminal History Check is cleared. After August 1st, Homes for All program staff requires a two-week notice before a proposed member start date. This is to ensure enrollment paperwork can be processed; program staff may conduct criminal history checks; and the living allowance set-up can be distributed properly. A site must receive written confirmation that a member is cleared to start service before a member may begin service hours, including orientation and training. Member Retention Service sites should work with Homes for All to address any circumstances that might lead to the early release of a member. Poor retention rates may result in funding cuts from ServeKY and the federal AmeriCorps agency for future service years. Service sites may not hire the member for positions at the site if this would require a member to exit their service early. If the member exit their service to pursue employment at the site, the organization may lose their awarded AmeriCorps slot and this agreement will be terminated. The organization may apply for AmeriCorps members in the future, but priority will be given to organizations that have complied with this provision. Homes for All acknowledges that members may choose to terminate their service on their own. Homes for All will provide efforts to address any member issues or concerns in cooperation with the service site. Service sites will not be penalized if they have made reasonable efforts to retain a member through communication and mediation.
Member Enrollment. The Contractor shall:
Member Enrollment. The Enrollment Date shall be the date that Employer submits the Enrollment Roster to MASA. The Parties agree that the method for enrollment shall be as follows: Electronic Enrollment Platform Manual (Paper Form) Both MASA MTS will provide Employer with an Enrollment Roster to assist Employer in the enrollment process. Employer should populate the Roster and submit the same to their MASA MTS Representative, identified above. Employer agrees to complete and/or amend, as needed, the Enrollment Roster in a timely manner. Additionally, Employer agrees to populate and maintain the Enrollment Roster with the most accurate and up-to-date information, as is reasonably possible. Upon enrollment, MASA MTS agrees to mail New Member Packets, including a membership card and explanation of benefits, to Employer to be distributed by Employer to employees. Membership Fees & Payment. MASA MTS agrees to provide the Emergent Plus Membership at a rate of one hundred and sixty dollars ($160.00) per employee per year. The total cost of the initial one (1) year term is calculated by taking the current headcount times the rate of $160.00. At the anniversary date of this Agreement, and every calendar year thereafter, MASA MTS will charge the one-half (1/2) the increase in headcount from the previous year, plus the new current headcount, times the rate of $160.00. [Example: (½ increase in headcount + new current headcount) x $160.00] Furthermore, if elected by Employer to allow upgrades via payroll deduction, the Employee will owe via payroll deduction the below rates monthly. Employer also agrees to submit the appropriate and coordinating payment to MASA MTS monthly. Monthly/Annual Platinum $25.67/$308 For recurring upgrade payments following the initial payment above, Employer acknowledges and agrees that Employer’s failure to make timely payment constitutes breach of this Agreement. For the purposes of this Agreement, “timely payment” shall be defined as payment made within thirty (30) days from the date identified in any bill and/or invoice submitted to Employer by MASA MTS. Failure to cure such a breach within fifteen (15) days of receiving written notice from MASA MTS may result in the termination of this Agreement. Waiver of such termination rights shall not prevent future enforcement of the same.
