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.
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Examples of New Enrollee in a sentence

  • 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 Information‌ The Contractor shall provide New Enrollees with Enrollee Information that meets the requirements of Section 2.8.C including a Provider directory that meets the requirements of Section 2.5.C and an Enrollee handbook based on a model provided by EOHHS, as further directed by EOHHS, that contains the Enrollee Information specified below.

  • 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 sixty (60) days and is automatically reinstated as a Health Plan Enrollee.

  • 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.

  • 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.

  • The New Enrollee Shortfall shall be the difference between the number of New Enrollees that CPMC was required to accept under the New Medi-Cal Beneficiaries Commitment for that fiscal year and the number of New Enrollees that CPMC did accept in that fiscal year.

  • 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.

  • New Enrollee Information‌ The Contractor shall provide New Enrollees with Enrollee Information that meets the requirements of Section 2.9.C including a Provider directory that meets the requirements of Section 2.6.D and an Enrollee handbook based on a model provided by EOHHS, as further directed by XXXXX, that contains the Enrollee Information specified below.

  • The steps outlined below are the minimum requirements that must be used in the scheduling and rescheduling of any non-mental health appointment and/or New Enrollee Appointment Request (NEAR).

  • We will help you decide what to do next and which qualified health care provider to go to.If you are new to HealthPartners, you will be receiving a New Enrollee survey to complete by mail.


More Definitions of New Enrollee

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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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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Related to New Enrollee

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

  • Newborn means a baby less than nine days old.

  • 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

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • 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.

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • 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.

  • New employee orientation means the onboarding process of a newly hired public employee, whether in person, online, or through other means or mediums, in which employees are advised of their employment status, rights, benefits, duties and responsibilities, or any other employment-related matters.

  • HMO means any health maintenance organization, managed care organization, any Person doing business as a health maintenance organization or managed care organization, or any Person required to qualify or be licensed as a health maintenance organization or managed care organization under applicable federal or state law (including, without limitation, HMO Regulations).

  • Retiree Health Plan means an "employee welfare benefit plan" within the meaning of Section 3(1) of ERISA that provides benefits to individuals after termination of their employment, other than as required by Section 601 of ERISA.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • MCP means a Material Change Proposal for the Station issued on [ ];

  • Child Caregiver means an individual providing basic childcare service needs for Your minor children under the age of 18 while You are on the Trip without the minor children. The arrangement of being the Child Caregiver while You are on the Trip must be made 30 or more days prior to the Scheduled Departure Date.

  • MCO means an organization having a certificate of authority or certificate of registration from the 11 Washington State Office of Insurance Commissioner that contracts with HCA under a comprehensive 12 risk contract to provide prepaid health care services to eligible HCA Enrollees under HCA managed 13 care programs.

  • Genetic counselor means a person licensed by the Board to engage in the practice of genetic

  • 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

  • Radiologist assistant means an individual who has met the requirements of the Board for licensure

  • Medical cannabis pharmacy means the same as that term is defined in Section 26-61a-102.

  • Pharmacy benefits management means the administration or management of prescription drug

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • Nursing diagnosis means a judgment made by a registered nurse, following a nursing assessment of individuals and groups about actual or potential responses to health problems, which forms the basis for determining effective nursing interventions.

  • graduate psychiatric nurse means a person whose name is entered on the register of graduate psychiatric nurses of the College of Registered Psychiatric Nurses of Manitoba. The terms of this Agreement shall be applicable to the graduate nurse, the graduate practical nurse, graduate psychiatric nurse, and graduate nurse practitioner, except as otherwise specified in the Collective Agreement.