Common use of ADJUSTMENTS TO PREMIUM Clause in Contracts

ADJUSTMENTS TO PREMIUM. 13.3.1 TDHS may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDHS or an agent or contractor of TDHS. TDHS may recoup premiums paid to HMO if a Member is enrolled into HMO in error, and HMO provided no covered services to Member for the period of time for which premium was paid. If services were provided to Member as a result of the error, recoupment will not be made. 13.3.2 TDHS may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and the HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDHS will not recoup premium if HMO has provided covered services to the Member during the period of time for which premium has been paid. 13.3.3 TDHS may recoup premium paid to HMO if a Member for whom premium is paid dies before the first day of the month for which premium is paid. 13.3.4 TDHS may recoup or adjust premium paid to HMO for a Member if the Members eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.3.5 Recoupment or adjustment of premium under 13.3.1 through 13.3.4 may be appealed using the TDHS dispute resolution process. 13.3.6 TDHS may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations or if a benefit or category of benefits is excluded or included as a covered service. Adjustment must be made by amendment as required by 15.2.2 TDHS/HMO CONTRACT August 11, 1999 96 103 Adjustment to premium under this subsection may not be appealed using the TDHS dispute process.

ADJUSTMENTS TO PREMIUM. 13.3.1 TDHS 1999 Renewal Contract Bexar Service Area August 9, 1999 13.4.1 TDH may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDHS TDH or an agent or contractor of TDHSTDH. TDHS TDH may recoup premiums paid to HMO if a Member is enrolled into HMO in error, and HMO provided no covered services to Member for the period of time for which premium was paid. If services were provided to Member as a result of the error, recoupment will not be made. 13.3.2 TDHS 13.4.2 TDH may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and the HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDHS TDH will not recoup premium if HMO has provided covered services to the Member during the period of time for which premium has been paid. 13.3.3 TDHS 13.4.3 TDH may recoup premium paid to HMO if a Member for whom premium is paid dies before the first day of the month for which premium is paid. 13.3.4 TDHS 13.4.4 TDH may recoup or adjust premium paid to HMO for a Member if the Members Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.3.5 13.4.5 Recoupment or adjustment of premium under 13.3.1 Articles 13.4.1 through 13.3.4 13.4.4 may be appealed using the TDHS TDH dispute resolution process. 13.3.6 TDHS 13.4.6 TDH may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations or and/or if a benefit or category of benefits is excluded or included as a covered service. Adjustment must be made by amendment as required by 15.2.2 TDHS/HMO CONTRACT August 11, 1999 96 103 Adjustment to premium under this subsection may not be appealed using the TDHS dispute process.Article

ADJUSTMENTS TO PREMIUM. 13.3.1 TDHS 13.4.1 HHSC may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDHS HHSC or an agent or contractor of TDHSHHSC. TDHS HHSC may recoup premiums paid to HMO if a Member is enrolled into HMO in error, and HMO provided no covered services to Member for the period of time for which premium was paid. If services were provided to Member as a result of the error, recoupment will not be made. 13.3.2 TDHS 13.4.2 HHSC may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and the HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDHS HHSC will not recoup premium if HMO has provided covered services to the Member during the period of time for which premium has been paid. 13.3.3 TDHS 13.4.3 HHSC may recoup premium paid to HMO if a Member for whom premium is paid dies before the first day of the month for which premium is paid. 13.3.4 TDHS 13.4.4 HHSC may recoup or adjust premium paid to HMO for a Member if the Members Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted.. STAR+PLUS BBA Amendment STAR+PLUS BBA Amendment Health and Human Services Commission 13.3.5 13.4.5 Recoupment or adjustment of premium under 13.3.1 Articles 13.4.1 through 13.3.4 13.4.4 may be appealed using the TDHS HHSC dispute resolution process. 13.3.6 TDHS 13.4.6 HHSC may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations or and/or if a benefit or category of benefits is excluded or included as a covered service. Adjustment must be made by amendment as required by 15.2.2 TDHS/HMO CONTRACT August 11, 1999 96 103 Adjustment to premium under this subsection may not be appealed using the TDHS dispute process.Article

ADJUSTMENTS TO PREMIUM. 13.3.1 TDHS 13.5.1 TDH may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDHS TDH or an agent or contractor of TDHSTDH. TDHS TDH may recoup premiums paid to HMO if a Member is enrolled into HMO in error, and HMO provided no covered services to Member for the period of time for which premium was paid. If services were provided to Member as a result of the error, recoupment will not be made.. 112 Dallas Service Area Contract 119 13.3.2 TDHS 13.5.2 TDH may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and the HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDHS TDH will not recoup premium if HMO has provided covered services to the Member during the period of time for which premium has been paid. 13.3.3 TDHS 13.5.3 TDH may recoup premium paid to HMO if a Member for whom premium is paid dies before the first day of the month for which premium is paid. 13.3.4 TDHS 13.5.4 TDH may recoup or adjust premium paid to HMO for a Member if the Members Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.3.5 13.5.5 Recoupment or adjustment of premium under 13.3.1 13.5.1 through 13.3.4 13.5.4 may be appealed using the TDHS TDH dispute resolution process. 13.3.6 TDHS 13.5.6 TDH may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations or and/or if a benefit or category of benefits is excluded or included as a covered service. Adjustment must be made by amendment as required by 15.2.2 TDHS/HMO CONTRACT August 11, 1999 96 103 Adjustment to premium under this subsection may not be appealed using the TDHS dispute process.Article

ADJUSTMENTS TO PREMIUM. 13.3.1 TDHS 13.4.1 HHSC may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDHS HHSC or an agent or contractor of TDHSHHSC. TDHS HHSC may recoup premiums paid to HMO if a Member is enrolled into HMO in error, and HMO provided no covered services to Member for the period of time for which premium was paid. If services were provided to Member as a result of the error, recoupment will not be made. 13.3.2 TDHS 13.4.2 HHSC may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and the HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDHS HHSC will not recoup premium if HMO has provided covered services to the Member during the period of time for which premium has been paid. 13.3.3 TDHS 13.4.3 HHSC may recoup premium paid to HMO if a Member for whom premium is paid dies before the first day of the month for which premium is paid. 13.3.4 TDHS 13.4.4 HHSC may recoup or adjust premium paid to HMO for a Member if the Members Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.3.5 13.4.5 Recoupment or adjustment of premium under 13.3.1 Sections 13.4.1 through 13.3.4 13.4.4 may be appealed using the TDHS HHSC dispute resolution process. 13.3.6 TDHS 13.4.6 HHSC may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations or and/or if a benefit or category of benefits is excluded or included as a covered service. Adjustment must be made by amendment as required by 15.2.2 TDHS/HMO CONTRACT August 11, 1999 96 103 Adjustment to premium under this subsection may not be appealed using the TDHS dispute processSection 15.

ADJUSTMENTS TO PREMIUM. 13.3.1 TDHS 13.4.1 TDH may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDHS TDH or an agent or contractor of TDHSTDH. TDHS TDH may recoup premiums paid to HMO if a Member is enrolled into HMO in error, and HMO provided no covered services to Member for the period of time for which premium was paid. If services were provided to Member as a result of the error, recoupment will not be made. 13.3.2 TDHS 13.4.2 TDH may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and the HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDHS TDH will not recoup premium if HMO has provided covered services to the Member during the period of time for which premium has been paid. 13.3.3 TDHS 13.4.3 TDH may recoup premium paid to HMO if a Member for whom premium is paid dies before the first day of the month for which premium is paid. 13.3.4 TDHS 13.4.4 TDH may recoup or adjust premium paid to HMO for a Member if the Members Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.3.5 13.4.5 Recoupment or adjustment of premium under 13.3.1 Articles 13.4.1 through 13.3.4 13.4.4 may be appealed using the TDHS TDH dispute resolution process. 13.3.6 TDHS 13.4.6 TDH may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations or and/or if a benefit or category of benefits is excluded or included as a covered service. Adjustment must be made by amendment as required by 15.2.2 TDHS/HMO CONTRACT August 11, 1999 96 103 Adjustment to premium under this subsection may not be appealed using the TDHS dispute process.Article