Medicare Enrollment The CONTRACTOR notifies the DEPARTMENT See description Denial in writing if Medicare does not allow an enrollment due to a residence in a given PARTICIPANT’S area. The notification must be provided within five (5) BUSINESS DAYS of the later of receipt of the enrollment file or notification by DEPARTMENT’S Medicare. See . The CONTRACTOR provides a comprehensive During the Transition Plan transition plan in a mutually agreed upon format implementation that provides a timeline of major tasks, activities, period, upon and information that will be provided to the DEPARTMENT succeeding vendor when relinquishing request, and prior responsibilities at termination of the CONTRACT. to CONTRACT See . termination 310B Deliverables to Participants Deliverable Description Frequency ID CARDS The CONTRACTOR provides PARTICIPANTS with ID Upon enrollment CARDS indicating, at a minimum, the EFFECTIVE and BENEFIT DATE of coverage, and the emergency room and office changes that visit copayment amounts. See . impact the information printed on the ID CARDS Participant The CONTRACTOR provides the following information, Upon enrollment Enrollment at a minimum, to PARTICIPANTS upon enrollment: Information Information about PARTICIPANT requirements, including PRIOR AUTHORIZATIONS and referrals. The PARTICIPATING PHARMACY directory or directions on how to request a printed copy of the provider directory. Directions on how to access the PARTICIPATING PHARMACY directory on the CONTRACTOR’S website. The contact information, including CONTRACTOR’S the dedicated toll-free customer service phone number, business hours, twenty-four (24)-hour nurse line, and website address. See . SUBSCRIBER The CONTRACTOR issues written notice to September Notification of PARTICIPANTS enrolled in its benefit plan(s) prior to Changes the OPEN ENROLLMENT period IT’S YOUR CHOICE identifying those PARTICIPATING PHARMACIES that will not be in-network for the upcoming benefit period and including any language directed by the DEPARTMENT summarizing any BENEFIT or other PHARMACY BENEFIT PLAN changes. See .
Medicare Enrollment Denial The CONTRACTOR notifies the DEPARTMENT in writing if Medicare does not allow an enrollment due to a PARTICIPANT’S residence in a given area. The notification must be provided within five (5) BUSINESS DAYS of the later of receipt of the DEPARTMENT’S enrollment file or notification by Medicare. See . See description Transition Plan The CONTRACTOR provides a comprehensive transition plan in a mutually agreed upon format that provides a timeline of major tasks, activities, and information that will be provided to the succeeding vendor when relinquishing responsibilities at termination of the CONTRACT. See . During the implementation period, upon DEPARTMENT request, and prior to CONTRACT termination 310B Deliverables to Participants Deliverable Description Frequency ID CARDS The CONTRACTOR provides PARTICIPANTS with ID CARDS indicating, at a minimum, the EFFECTIVE DATE of coverage, and the emergency room and office visit copayment amounts. See . Upon enrollment and BENEFIT changes that impact the information printed on the ID CARDS Participant Enrollment Information The CONTRACTOR provides the following information, at a minimum, to PARTICIPANTS upon enrollment: Information about PARTICIPANT requirements, including PRIOR AUTHORIZATIONS and referrals. The PARTICIPATING PHARMACY directory or directions on how to request a printed copy of the provider directory. Directions on how to access the PARTICIPATING PHARMACY directory on the CONTRACTOR’S website. The CONTRACTOR’S contact information, including the dedicated toll-free customer service phone number, business hours, twenty-four (24)-hour nurse line, and website address. See . Upon enrollment SUBSCRIBER Notification of Changes The CONTRACTOR issues written notice to PARTICIPANTS enrolled in its benefit plan(s) prior to the IT’S YOUR CHOICE OPEN ENROLLMENT period identifying those PARTICIPATING PHARMACIES that will not be in-network for the upcoming benefit period and including any language directed by the DEPARTMENT summarizing any BENEFIT or other PHARMACY BENEFIT PLAN changes. See . September
Exhibit1-PBP_Agreement_Rev01-04-2017_clean.docx