ACA Health Insurer Fee Sample Clauses

ACA Health Insurer Fee. (A) The Contractor is responsible for paying the annual Health Insurer Fee. (B) The monthly Capitation Rates found in Attachment F include the Health Insurer Fee as well as any associated state and federal taxes directly arising out of the Health Insurer Fee. The Department shall incorporate funding for the Health Insurer Fee into the Capitation Rates on a prospective basis. The Capitation Rates shall be adjusted as needed each year to ensure actuarial soundness. During the Capitation Rate adjustment the Department shall reconcile the new Capitation Rate by the amounts of the Health Insurer Fee incorporated into the previous year’s Capitation Rate which the Department has determined (through actuarial certification) has been overpaid or underpaid during the previous fiscal year. (C) The Department shall fund the Health Insurer Fee up to the amount appropriated by the Utah state legislature. The Department may request an appropriation from the Utah legislature for additional funding in the event the Department determines through actuarial certification that the amount appropriated by the Utah legislature does not adequately cover incorporation of the Health Insurer Fee into the new Capitation Rates. (D) By September 30 of each year, the Contractor shall provide to the Department its Health Insurer Fee invoice relating to the premiums paid to the Contractor under this contract. The Contractor shall also provide any additional supporting documentation relating to the Health Insurer Fee requested by the Department. (E) The Contractor agrees not to pursue legal action whatsoever against the Department or its officers, employees, or agents with respect to the Health Insurer Fee.
AutoNDA by SimpleDocs
ACA Health Insurer Fee. The Department acknowledges that it may have an obligation to the PH-MCO in the matter of the Patient Protection and Affordable Care Act, Section 9010 Health Insurance Providers Fee. For those PH-MCOs with a liability for payment of this fee, the Department’s actuary intends to recognize the costs associated with this fee for payment to the plans consistent with guidance from CMS. The Department plans to include provision in future agreement amendments to provide potential payments to the PH-MCO. HealthChoices Physical Health Agreement Effective July 1, 2013 3a-1 Federal HC Agreements 13-14 Amendment – Vista Updated November 6, 0000

Related to ACA Health Insurer Fee

  • Group Health Insurance The Employer shall provide a comprehensive health care insurance program for all permanent full-time and part-time employees. Health Plan characteristics and benefits shall be as provided in the Employer’s Agreement with the Ohio Civil Service Employees Association (hereinafter OCSEA). Regardless of the plan, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; however for any alternative plans offered pursuant to the Agreement with OCSEA, the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. The Employer’s premium share shall be paid on behalf of eligible employees as provided in the Employer’s Agreement with OCSEA. Employees who include a spouse as a dependent for healthcare coverage shall pay a surcharge as provided in the Employer’s Agreement with OCSEA. Eligibility provisions for employees enrolling in State provided health care plans shall remain the same as those in effect in the Employer’s Agreement with OCSEA. The Employer reserves the right to perform dependent eligibility audits upon recommendation of the Joint Health Care Committee. Health care costs paid on behalf of ineligible dependents will be subject to recovery. Deductibles, co-payments, and other plan design provisions for all benefit programs shall be the same as those prescribed in the Employer’s Agreement with OCSEA. Every year the Employer shall conduct an open enrollment period, at which time employees shall be able to enroll in a health plan, continue enrollment in their current plan, switch to another plan, subject to plan availability in their area, or waive coverage. The timing of the open enrollment period shall be established by the Director of the Department of Administrative Services (DAS), in consultation with the Joint Health Care Committee. Changes outside of open enrollment may only occur as prescribed in the Employer’s Agreement with OCSEA. Open Enrollment Fairs shall be held in accordance with Employer’s Agreement with OCSEA. There shall be established a Joint Health Care Committee composed of representatives of management, and of the various labor Unions representing State employees. The Committee shall meet regularly to monitor the operation of the State’s health care plans, and to make recommendations for the improvement of the plans and cost containment procedures. The Employer shall provide funding for dental, vision and the life benefits as described in Article 21 of the Employer’s Agreement with OCSEA and the Union’s Benefits Trust. Employee health insurance payments will be deducted from every paycheck. In the event an employee is receiving disability leave or Workers’ Compensation benefits, the Employer- policyholder shall continue, at no cost to the employee, the coverage of group health insurance for such employee for the period of such leave, but not beyond twelve (12) months. If the employee’s leave extends beyond twelve

  • Health Insurance The Couple agrees that: (check one)

  • Retiree Health Insurance Retired members of the Department receiving, or to receive City of Lincoln monthly pension checks, may participate in the group comprehensive health care plan for active City employees, provided that each retiree so desiring will execute the required forms in a timely fashion, and further provided that each retiree will be required to pay the full monthly cost at the current rates subject to any rate increases which may occur from time to time. Such payment will be made by payroll deduction from pension checks, or by direct payment in the case of an early retiree.

  • Health Insurance Benefits To the extent provided by the federal COBRA law or, if applicable, state insurance laws, and by the Company’s current group health insurance policies, Executive will be eligible to continue Executive’s group health insurance benefits at Executive’s own expense. If Executive timely elects continued coverage under COBRA, the Company shall pay Executive’s COBRA premiums, and any applicable Company COBRA premiums, necessary to continue Executive’s then-current coverage for a period of 12 months after the date of Executive’s termination of employment; provided, however, that any such payments will cease if Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such premiums. Executive agrees to immediately notify the Company in writing of any such enrollment. Notwithstanding the foregoing, if the Company determines, in its sole discretion, that it cannot provide the foregoing benefit without potentially incurring financial costs or penalties under applicable law (including, without limitation, Section 2716 of the Public Health Service Act), the Company shall in lieu thereof provide to Executive a taxable monthly amount to continue his group health insurance coverage in effect on the date of separation from service (which amount shall be based on the premium for the first month of COBRA coverage), which payments shall be made regardless of whether Executive elects COBRA continuation coverage and shall commence in the month following the month in which Executive incurs a separation from service and shall end on the earlier of (x) the date on which Executive voluntarily enrolls in a health insurance plan offered by another employer or entity during the period in which the Company is paying such amounts and (y) 12 months after the date of Executive’s separation from service.

  • Health insurance premiums If you are unemployed and have received unemployment compensation for 12 consecutive weeks under a federal or state program, you may take payments from your IRA to pay for health insurance premiums without incurring the 10 percent early distribution penalty tax.

  • Health Insurance Portability and Accountability Act of 1996 This paragraph was intentionally left blank.

  • Health Insurance Portability and Accountability Act Grantee certifies that it is in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law Xx. 000-000, 00 XXX Parts 160, 162 and 164, and the Social Security Act, 42 USC 1320d-2 through 1320d-7, in that it may not use or disclose protected health information other than as permitted or required by law and agrees to use appropriate safeguards to prevent use or disclosure of the protected health information. Grantee shall maintain, for a minimum of six (6) years, all protected health information.

  • Health Insurance Coverage (a) An employee who is laid off or separated from employment on or after July 1, 1994, under circumstances which entitle such employee to reemployment rights under this Article, other than pursuant to Section 23, may elect to continue membership in their health benefit plan, upon advance payment of the regular percentage contribution to the cost of the plan, during the first six

  • Drug and Alcohol Policy 67.1 The Parties agree to apply the Drug and Alcohol Management Program (as amended from time to time) contained in Appendix G. 67.2 The Employer may refer an Employee affected by drugs or alcohol to the services provided by Incolink.

  • EMPLOYEE BENEFIT PROGRAM (i) During the TERM, the EMPLOYEE shall be entitled to participate in all formally established employee benefit, bonus, pension and profit-sharing plans and similar programs that are maintained by the EMPLOYERS from time to time, including programs in respect of group health, disability or life insurance, reimbursement of membership fees in civic, social and professional organizations and all employee benefit plans or programs hereafter adopted in writing by the Boards of Directors of the EMPLOYERS, for which senior management personnel are eligible, including any employee stock ownership plan, stock option plan or other stock benefit plan (hereinafter collectively referred to as the "BENEFIT PLANS"). Notwithstanding the foregoing sentence, the EMPLOYERS may discontinue or terminate at any time any such BENEFIT PLANS, now existing or hereafter adopted, to the extent permitted by the terms of such plans and shall not be required to compensate the EMPLOYEE for such discontinuance or termination. (ii) After the expiration of the TERM or the termination of the employment of the employee for any reason other than JUST CAUSE (as defined hereinafter), the EMPLOYERS shall provide a group health insurance program in which the EMPLOYEE and her spouse will be eligible to participate and which shall provide substantially the same benefits as are available to retired employees of the EMPLOYERS on the date of this AGREEMENT until both the EMPLOYEE and her spouse become 65 years of age; provided, however that all premiums for such program shall be paid equally by the EMPLOYERS and the EMPLOYEE and/or her spouse after the EMPLOYEE's retirement; provided further, however, that the EMPLOYEE may only participate in such program for as long as the EMPLOYERS elect in their sole discretion to make available an employee group health insurance program which permits the EMPLOYERS to make coverage available for retirees.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!