Common use of Notice to Enrollees Clause in Contracts

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that: • One of the Primary Care Providers they have used in the past is no longer available, and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or • One of the major Subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services. • The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll at the end of any month. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination.

Notice to Enrollees. If the STATE determines there is a Material Modification, the MCO shall provide prior written notification to Enrollees who will be affected by such a Material Modification. The MCO shall submit such notice to the STATE for prior approval. The notice must inform each affected Enrollee that: •  One of the Primary Care Providers they have used in the past is no longer available, and the Enrollee must choose a new Primary Care Provider from the MCO’s remaining choices; or that the Enrollee has been reassigned from a terminated sole source Provider; or •  One of the major Subcontractors providing a network of Providers, including but not limited to the behavioral health network, pharmacy benefit manager, or dental network will no longer be available in the MCO’s network and that access to these services may require that the Enrollee choose a different provider for these services. •  The notice shall also inform the Enrollee that the Enrollee has the opportunity to disenroll at the end of any monthtime. The MCO shall fully cooperate with the STATE and Local Agency to facilitate a change of MCO for Enrollees affected by the Provider termination.