美国一家医疗机构的chargeback政策
关于WellCare Health Plans，Inc。
WellCare Health Plans，Inc。（纽约证券交易所股票代码：WCG）总部位于佛罗里达州坦帕市，专注于通过医疗补助，医疗保险优惠和医疗保险处方药计划向家庭，儿童，老年人和个人提供政府资助的管理式医疗服务。复杂的医疗需求。截至2018年3月31日，该公司在全国范围内为大约430万会员提供服务。
WellCare的专业知识
WellCare在政府资助的三个主要医疗领域开发了全面的专业知识：Medicaid，Medicare Advantage和Medicare Prescription Drug Plans。利用我们的专业知识是我们为会员带来价值的关键部分。我们致力于不断提高我们为会员提供的护理和服务质量，帮助他们在适当的环境中及时获得正确的护理。
Chargeback Methodology 退款方法
1. Chargebacks are defined as recovering compensation that was "advanced" in a plan year for months the member was not on the plan. The first 3 months are considered "Rapid Disenrolls" (RDEs) and are charged back for 100% of the commission. Any disenrolls between 4 and 11 months are recovered on a pro-rated basis. Chargebacks will be utilized to recover compensation payments from agents any time a commission is advanced and the beneficiary disenrolls prior to commission advance proration hitting zero.
退款被定义为：恢复在计划年度中“提前”的成员不在计划中的补偿。前3个月被视为“快速公告”（RDEs），并按100％的佣金收取。4到11个月之间的任何失效都按比例收回。退款将用于在佣金提前的任何时候从代理商处收回补偿金，并且受益人在佣金提前按比例达到零之前退出。
例外：
一个。10月1日，11月1日和12月1日的入学不被视为RDEs
会员于1月1日退出生效。标准RDE方法适用于
在1月1日之前退出（即10月入学，但12月退学有效）。
湾 由于以下原因而从D部分中删除：
一世。其他可信的保险范围
II。制度化
C。特殊情况下：
一世。获得或减少雇主赞助的保险范围
II。为了协调D部分注册期
III。为了与SPAP协调
IV。追溯医疗保险权利的通知
d。状态变化：
一世。成为双重资格
II。根据特殊需求获得另一项计划的资格
III。成为LIS资格
IV。符合基于慢性病的另一项计划
v。进出机构
六。由于自动便利的注册
即 非自愿的DE：
一世。死亡
II。停止服务区
III。不支付保费
IV。丧失权利
v。追溯权利通知
六。CMS制裁或违反合同
七。计划不续签或终止
F。5星评分SEP
Exceptions:
a. October 1, November 1, and December 1 enrollments are not considered RDEs if the
member disenrolls for a January 1 Effective. Standard RDE methodology applies for
disenrolls prior to January 1 (i.e. October enrollment, but disenrolling for December effective).
b. Disenrolls from Part D due to:
i. Other creditable coverage
ii. Institutionalization
c. Exceptional Circumstances:
i. Gains or drops employer sponsored coverage
ii. In order to coordinate with Part-D enrollment periods
iii. In order to coordinate with an SPAP
iv. Retroactive notice of Medicare entitlement
d. Changes in Status:
i. Becoming dual eligible
ii. Qualifying for another plan based on special needs
iii. Becoming LIS eligible
iv. Qualifying for another plan based on chronic conditions
v. Moving into or out of an institution
vi. Due to an auto-facilitated enrollments
e. Involuntary DEs:
i. Death
ii. Out of Service Area
iii. Non-payment of Premium
iv. Loss of entitlement
v. Retroactive notice of entitlement
vi. CMS sanctions or Contract violation
vii. Plan non-renewal or termination
f. 5 Star Score SEP
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