Common use of Valid Reasons for Disenrollment Clause in Contracts

Valid Reasons for Disenrollment. (A) The Contractor may initiate disenrollment of any Enrollee’s participation in the Health Plan upon one or more of the following grounds: (1) For reasons specifically identified in the Contractor’s member handbook; (2) When the Enrollee ceases to be eligible for medical assistance under the State Plan in accordance with 42 USC 1396, et seq. and as finally determined by the Department; (3) Upon termination or expiration of the Contract; (4) Death of the Enrollee; (5) Confinement of the Enrollee in an institution when confinement is not a Covered Service under this Contract; (6) Violation of enrollment requirements developed by the Contractor and approved by the Department but only after the Contractor and/or the Enrollee has exhausted the Contractor’s applicable internal Grievance procedure; or (7) As allowed by Article 2.2 of Attachment C and Attachment D.

Valid Reasons for Disenrollment. (A) The Contractor may initiate disenrollment of any Enrollee’s participation in the Health Plan upon one or more of the following grounds: (1) For reasons specifically identified in the Contractor’s member Enrollee handbook; (2) When the Enrollee ceases to be eligible for medical assistance under the State Plan in accordance with 42 USC 1396, et seq. and as finally determined by the Department; (3) Upon termination or expiration of the Contract; (4) Death of the Enrollee; (5) Confinement of the Enrollee in an institution when confinement is not a Covered Service under this the Contract; (6) Violation of enrollment requirements developed by the Contractor and approved by the Department but only after the Contractor and/or the Enrollee has exhausted the Contractor’s applicable internal Grievance procedure; or (7) As allowed by Article 2.2 of Attachment C and Attachment D.

Valid Reasons for Disenrollment. (A) The Contractor may initiate disenrollment of any Enrollee’s participation in the Health Plan upon one or more of the following grounds: (1) For reasons specifically identified in the Contractor’s member handbook; (2) When the Enrollee ceases to be eligible for medical assistance under the State Plan in accordance with 42 USC 1396, et seq. and as finally determined by the Department; (3) Upon termination or expiration of the Contract; (4) Death of the Enrollee; (5) Confinement of the Enrollee in an institution when confinement is not a Covered Service under this Contract;; or (6) Violation of enrollment requirements developed by the Contractor and approved by the Department but only after the Contractor and/or the Enrollee has exhausted the Contractor’s applicable internal Grievance procedure; or (7) As allowed by Article 2.2 of Attachment C and Attachment D..