Common use of ADJUSTMENTS TO PREMIUM Clause in Contracts

ADJUSTMENTS TO PREMIUM. 13.4.1 HHSC may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of HHSC or an agent or contractor of HHSC. 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 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. 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 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 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 Sections 13.4.1 through 13.4.4 may be appealed using the HHSC dispute resolution process. 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 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 Section 15.

ADJUSTMENTS TO PREMIUM. 13.4.1 HHSC TDH may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of HHSC TDH or an agent or contractor of HHSCTDH. HHSC 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 HHSC 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. HHSC 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 HHSC 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 HHSC 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 Sections Articles 13.4.1 through 13.4.4 may be appealed using the HHSC TDH dispute resolution process. 13.4.6 HHSC 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 Section 15.Article

ADJUSTMENTS TO PREMIUM. 13.4.1 HHSC may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of HHSC or an agent or contractor of HHSC. 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 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. 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 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 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 Sections Articles 13.4.1 through 13.4.4 may be appealed using the HHSC dispute resolution process. 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 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 Section 15.Article

ADJUSTMENTS TO PREMIUM. 1999 Renewal Contract Bexar Service Area August 9, 1999 13.4.1 HHSC TDH may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of HHSC TDH or an agent or contractor of HHSCTDH. HHSC 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 HHSC 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. HHSC 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 HHSC 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 HHSC 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 Sections Articles 13.4.1 through 13.4.4 may be appealed using the HHSC TDH dispute resolution process. 13.4.6 HHSC 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 Section 15.Article

ADJUSTMENTS TO PREMIUM. 13.4.1 HHSC 13.3.1 TDHS may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of HHSC TDHS or an agent or contractor of HHSCTDHS. HHSC 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 HHSC 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. HHSC 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 HHSC 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 HHSC 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 Sections 13.4.1 13.3.1 through 13.4.4 13.3.4 may be appealed using the HHSC TDHS dispute resolution process. 13.4.6 HHSC 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 Section 1515.2.2 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. 13.4.1 HHSC 13.5.1 TDH may recoup premiums paid to HMO in error. Error may be either human or machine error on the part of HHSC TDH or an agent or contractor of HHSCTDH. HHSC 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 HHSC 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. HHSC 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 HHSC 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 HHSC 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 Sections 13.4.1 13.5.1 through 13.4.4 13.5.4 may be appealed using the HHSC TDH dispute resolution process. 13.4.6 HHSC 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 Section 15.Article