Late Enrollees definition

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Late Enrollees means Applicant or Dependents who request enrollment in a health benefit plan after the initial open enrollment period. An individual will not be considered a Late Enrollee if: (a) the person enrolls during his/her initial enrollment period under the Contract: (b) the person enrolls during a special enrollment period; or (c) a court orders that coverage be provided for a minor Covered Dependent under a Member’s Contract, but only as long as the Member requests enrollment for such Dependent within sixty (60) days after the court order is issued. Late Enrollees are those who declined coverage during the initial open enrollment period and did not submit a certification to us that coverage was declined because other coverage existed. Clear plastic single vision, bifocal or trifocal corrective materials which are ground as prescribed by a licensed Provider. Long Term Acute Care requires a Hospital environment which provides the patient with daily Physician visits, a critical care and medical/surgical experienced nursing staff, a complete respiratory department (24 hours a day, 7 Maternity Care Maximum Allowed Cost or Maximum Allowable Charge (MAC) Maximum Allowed Cost and/or Maximum Allowable Charge shall mean the maximum amount payable for a Covered Service under the Contract and meeting Medical Necessity and Prior Authorization requirements. The MAC will not include any identifiable billing mistakes including, but not limited to, up-coding, unbundled services/charges, duplicate charges, and charges for services not performed. An MCSO is any court judgment, decree or order (including a court’s approval of a domestic relations settlement agreement) that: • Provides for child support payment related to health benefits with respect to the child of a health plan participant or requires health benefit coverage of such child in such plan, and is ordered under state domestic relations law; or • Enforces a state law relating to medical child support payment with respect to a health plan. Medical Facility Any Hospital, ambulatory care facility, Chemical Dependency Treatment Facility, Skilled Nursing facility, Home Health Care Agency or mental health facility, as defined in this Certificate. The facility must be licensed, registered or approved by the Joint Commission on Accreditation of Hospitals or meet specific requirements established by us. We reserve the right to determine whether a health care service or supply is Medically Necessary. The fact that a Physician ha...

Examples of Late Enrollees in a sentence

In addition, an Employee [and any Dependents] will not be considered [a] Late Enrollee[s] if the Employee is employed by an employer which offers multiple Health Benefits Plans and the Employee elects a different plan during the open enrollment period.
In addition, if an Employee initially waived coverage under this Contract for the Employee's spouse or eligible Dependent children because the spouse and/or Dependent children had coverage under a Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision and the Employee requests coverage for the spouse and/or Dependent children under this Contract within 30 days of the date the COBRA continuation ended, We will not consider the spouse and/or Dependent children to be Late Enrollees.
A period of time that is no less than 30 days or 60 days, as applicable, following the date of a Triggering Event during which: Late Enrollees are permitted to enroll under the Contractholder’s Policy; and Covered Employees and Dependents who already have coverage are permitted to replace current coverage with coverage under a different policy, if any, offered by the Contractholder.
If the Employee's dependent coverage ends for any reason, including failure to make the required payments, his or her Dependents will be considered Late Enrollees when their coverage begins again.
The 30-day period each year designated by the Contractholder during which: Employees and Dependents who are eligible under the Contract but who are Late Enrollees may enroll for coverage under the Contract; and Employees and Dependents who are covered under Contract may elect coverage under a different policy, if any, offered by the Contractholder.
This opt out coverage shall be for one year, unless an employee and/or his eligible Dependent(s) are covered under another plan and subsequently involuntarily lose such coverage; such individuals will not be considered Late Enrollees should they wish to re-enroll in this Plan.
You and your Dependents will not be considered to be Late Enrollees if either you or your Dependents lose coverage un- der another employer health plan and you apply for coverage under this Plan within 31 days of the date of loss of coverage.
If an employee and/or his eligible Dependent(s) are covered under another plan and subsequently involuntarily lose such coverage, such individuals will not be considered Late Enrollees should they wish to enroll in this Plan.
This brochure is also available at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ for HMO Members.) When you do not enroll yourself or your Dependents during the initial enrollment period and later apply for coverage, you and your Dependents will be considered to be Late Enrollees.
When Late Enrollees decline coverage during the initial en- rollment period, they will be eligible the earlier of, 12 months from the date of application for coverage or at the Employer’s next Open Enrollment Period.

More Definitions of Late Enrollees

Late Enrollees means Employees or Dependents who request enrollment in a health benefit plan after the initial open enrollment period. An individual will not be considered a Late Enrollee if: (a) the person enrolls during his/her initial enrollment period under the Contract: (b) the person enrolls during a special enrollment period; or (c) a court orders that coverage be provided for a minor Covered Dependent under a Member’s Contract, but only as long as the Member requests enrollment for such Dependent within sixty (60) days after the court order is so issued. Late Enrollees are those who declined coverage during the initial open enrollment period and did not submit a certification to us that coverage was declined because other coverage existed. Clear plastic single vision, bifocal or trifocal corrective materials which are ground as prescribed by a licensed Provider. Long Term Acute Care requires a Hospital Environment which provides the patient with daily Physician visits, a critical care and medical/surgical experienced nursing staff, a complete respiratory department (24 hours a day, 7 days a week), an in-house rehab department, case management, social services, an in-house pharmacy, radiology, an operating room, an ICU, and a complete health care system designed to meet the needs of highly acute patients. This acute care environment promotes timely and effective responses to maximize the recovery potential of the patient, and prevents the need for discharge when complications arise. Such care differs from skilled nursing facility/subacute facility care because that care is limited in the range and frequency of services provided and does not offer a complete health care delivery system.