New Enrollee definition

New Enrollee means an employee who was not enrolled in the plan as of the implementation date referenced at Section B.
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New Enrollee. An Eligible Person who has become a first-time Enrollee of the GHP . Occupation Level: A measure of how much time Call Center Choice Counselors spend on live calls and/or completing work related to those calls. Open Enrollment: A period of ninety (90) Calendar Days during which Enrollees have one (1) opportunity to select a different MCO or PCP, without cause, as set forth in Section 5.3 of this Contract. Personal Health Information (“PHI”): Per 42 CFR Part 160 and 42 CFR Part 164, individually identifiable health Information that is transmitted by electronic media, maintained in electronic media, or transmitted or maintained in any other form or medium. Potential Enrollee: A person who has been certified by the Puerto Rico Medicaid Program as eligible to enroll in the GHP (whether on the basis of Medicaid eligibility, CHIP eligibility, or eligibility as a member of the State Population), but who has not yet enrolled with the GHP Program or with an MCO.
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New Enrollee. An Eligible Person who became a Potential Enrollee after November 1, 2018. Non-Emergency Medical Transportation (“NEMT”): A ride, or reimbursement for a ride, provided so that an Enrollee with no other transportation resources can receive Covered Services from a Provider. NEMT does not include transportation provided on an emergency basis, such as trips to the emergency room in life threatening situations. Notice of Adverse Benefit Determination: The written notice described in Section 14.4.3 of the ASES Contract, in which the Contractor notifies both the Enrollee and the Provider of an Adverse Benefit Determination.
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Examples of New Enrollee in a sentence

  • Once the Care Management Team is informed that an individual is enrolled in the Plan, staff reaches out to the enrollee through written materials, telephonically and face to face, to welcome them to the Plan, and gather the HRA as well as documenting our New Enrollee interview.

  • New Enrollee – any Enrollee enrolled by EOHHS pursuant to Section 2.4 who has not been previously enrolled in the Contractor’s Plan within the preceding 12 months, or within another timeframe as determined by EOHHS.

  • If the defined New Enrollee Capitation is greater than 50% of the Total Population Capitation, the defined New Enrollees capitation and expenses may be deferred to the next MLR period.

  • Add the New Enrollee expenses deferred from the prior MLR reporting year as defined on page 28 of this guide.

  • Add the New Enrollee capitation deferred from the prior MLR reporting year as defined on page 28 of this guide.

  • New Enrollee materials are not required for a former Enrollee who was disenrolled because of the loss of Medicaid eligibility and who regains his/her eligibility within 180 days and is automatically reinstated as a Health Plan Enrollee.

  • The Average Life Cost shall mean the average unreimbursed cost per fiscal year to CPMC for providing services to each New Enrollee over the previous two (2) fiscal years.

  • Subtract the New Enrollee capitation and expense impact for the current MLR reporting year as defined on page 28 of this guide.

  • Options – Please select from the New Enrollment section OR the Transfer section based on your enrollment status.NEW ENROLLMENT – Circle one of the following: New Hire, New Enrollee or TRANSFER from another SHBP covered Agency or School Returning Member with break in coverage who missed an Open Enrollment.

  • New Enrollee – any Enrollee enrolled by EOHHS pursuant to Section 2.5 who has not been previously enrolled in the Contractor within the preceding 12 months, or within another timeframe as determined by EOHHS.


More Definitions of New Enrollee

New Enrollee. An Eligible Person who became a Potential Enrollee after January 1, 2023. Non-Emergency Medical Transportation (“NEMT”): A ride, or reimbursement for a ride, provided so that an Enrollee with no other transportation resources can receive Covered Services from a Provider. NEMT does not include transportation provided on an emergency basis, such as trips to the emergency room in life threatening situations.
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New Enrollee. An Eligible Person who became a Potential Enrollee after November 1, 2018.
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Related to New Enrollee

  • Enrollee means any person entitled to health care services from a carrier.

  • Health plan or "health benefit plan" means any policy,

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • CMS means the Centers for Medicare and Medicaid Services.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • HMO means health maintenance organization.

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79