Enrollment Application definition

Enrollment Application means the information submitted by or on behalf of an individual to the Exchange in connection with a request to enroll as either a Subscriber or Dependent. Exchange means the District of Columbia Health Benefit Exchange (DC HBX).

Split View

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

Get StartedSchedule a Demo

Enrollment Application means the form or forms prescribed by RCI from time to time for enrollment of Members in the RCI Weeks Exchange Program.

Enrollment Application means the form approved by the Plan by which the Subscriber seeks to enroll one or more Members in the Plan.

Examples of Enrollment Application in a sentence

• This Agreement is issued as a Child-Only Agreement where an eligible Qualified Individual and Application Filer submit an Enrollment Application to the Exchange that requests Child-Only Coverage for the Subscriber.

• Your completed Enrollment Application and schedule of Principal Benefits and Coverage under which you are enrolled along with this Group Subscriber Agreement, Combined Evidence of Coverage and Disclosure Form, will constitute the entire Agreement.

• This Agreement is issued as a Child-Only Agreement where an eligible Qualified Individual or Application Filer submits an Enrollment Application to the Exchange that requests Child-Only Coverage for the Subscriber.

• Subscribers agree that CDN shall provide services set forth in this Group Subscriber Agreement, Combined Evidence of Coverage and Disclosure Form at the rates specified in the Enrollment Application and the Benefit Schedule upon payment of the monthly or annual Prepayment Fee.

• Employee Enrollment Application – SDIS will create and maintain a Member Group specific form.

More Definitions of Enrollment Application

Enrollment Application means the form approved by the Plan by which an individual seeks to enroll one or more Members in the Plan.

Enrollment Application means the form approved by the Plan which the Subscriber fills out to enroll one or more Members in the Plan. Members must select an Affiliated Physician/PCP on this application.

Enrollment Application means the agreement executed by the Employee, establishing the Employee’s participation under this Agreement.

Enrollment Application means any enrollment forms or procedures, including payroll deduction authorizations, effectuated by any means prescribed by the Plan Administrator or its designee, including by means of internet or telephone-based communications.

Enrollment Application means the information submitted by or on behalf of an individual to the Exchange in connection with a request to enroll under this Agreement as either a Subscriber or Dependent.

Enrollment Application means the information submitted by or on behalf of an individual to the Exchange in connection with a request to enroll as either a Subscriber or Dependent. Exchange means the District of Columbia Health Benefit Exchange (DC HBX). Exclusive Specialty Pharmacy Network means a pharmacy network that is limited to certain specialty Pharmacies that have been designated as “Exclusive” by CareFirst. Members may contact CareFirst for a list of Pharmacies in the Exclusive Specialty Pharmacy Network. Experimental/Investigational means a service or supply in the developmental stage and in the process of human or animal testing excluding patient costs for clinical trials as stated in the Description of Covered Services. Services or supplies that do not meet all five of the criteria listed below are deemed to be Experimental/Investigational:

Enrollment Application means the form to be accurately completed by prospective Enrollees when they apply for enrollment under the Plan.