Common use of ADJUSTMENTS TO PREMIUM Clause in Contracts

ADJUSTMENTS TO PREMIUM. 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 TDH or an agent or contractor of TDH. 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. 13.4.2 TDH may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and HMO has not provided covered services to the Member for the period of time for which premium has been paid. 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. 13.4.3 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. 13.4.4 TDH may recoup or adjust premium paid to HMO for a Member if the Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.4.5 Recoupment or adjustment of premium under Articles 13.4.1 through 13.4.4 may be appealed using the TDH dispute resolution process. 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 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 Article

ADJUSTMENTS TO PREMIUM. 1999 Renewal Contract Bexar Service Area August 9, 1999 13.4.1 TDH HHSC may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDH HHSC or an agent or contractor of TDHHHSC. TDH 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. 13.4.2 TDH HHSC may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDH 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. 13.4.3 TDH 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. 13.4.4 TDH HHSC may recoup or adjust premium paid to HMO for a Member if the 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 13.4.5 Recoupment or adjustment of premium under Articles 13.4.1 through 13.4.4 may be appealed using the TDH HHSC dispute resolution process. 13.4.6 TDH HHSC may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations 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 Article

ADJUSTMENTS TO PREMIUM. 1999 Renewal Contract Bexar Service Area August 9, 1999 13.4.1 TDH 13.3.1 TDHS may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDH TDHS or an agent or contractor of TDHTDHS. TDH 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. 13.4.2 TDH 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. TDH 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. 13.4.3 TDH 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. 13.4.4 TDH 13.3.4 TDHS may recoup or adjust premium paid to HMO for a Member if the Member's Members eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.4.5 13.3.5 Recoupment or adjustment of premium under Articles 13.4.1 13.3.1 through 13.4.4 13.3.4 may be appealed using the TDH TDHS dispute resolution process. 13.4.6 TDH 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 and/or 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 Article15.2.2 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. 1999 Renewal Contract Bexar Service Area August 9, 1999 13.4.1 TDH HHSC may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDH HHSC or an agent or contractor of TDHHHSC. TDH 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. 13.4.2 TDH HHSC may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and HMO has not provided covered services to the Member for the period of time for which premium has been paid. TDH 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. 13.4.3 TDH 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. 13.4.4 TDH HHSC may recoup or adjust premium paid to HMO for a Member if the Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.4.5 Recoupment or adjustment of premium under Articles Sections 13.4.1 through 13.4.4 may be appealed using the TDH HHSC dispute resolution process. 13.4.6 TDH HHSC may adjust premiums for all Members within an eligibility status or program type if adjustment is required by reductions in appropriations 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 ArticleSection 15.

ADJUSTMENTS TO PREMIUM. 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 TDH or an agent or contractor of TDH. 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. 13.4.2 TDH may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and HMO has not provided covered services to the Member for the period of time for which premium has been paid. 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. 13.4.3 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. 13.4.4 TDH may recoup or adjust premium paid to HMO for a Member if the Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.4.5 Recoupment or adjustment of premium under Articles 13.4.1 through 13.4.4 may be appealed using the TDH dispute resolution process. 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 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 Article

ADJUSTMENTS TO PREMIUM. 1999 Renewal Contract Bexar Service Area August 9, 1999 13.4.1 13.5.1 TDH may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of TDH or an agent or contractor of TDH. 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 13.4.2 13.5.2 TDH may recoup premium paid to HMO if a Member for whom premium is paid moves outside the United States, and HMO has not provided covered services to the Member for the period of time for which premium has been paid. 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. 13.4.3 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. 13.4.4 13.5.4 TDH may recoup or adjust premium paid to HMO for a Member if the Member's eligibility status or program type is changed, corrected as a result of error, or is retroactively adjusted. 13.4.5 13.5.5 Recoupment or adjustment of premium under Articles 13.4.1 13.5.1 through 13.4.4 13.5.4 may be appealed using the TDH dispute resolution process. 13.4.6 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 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 Article