Common use of Authorized Functions Clause in Contracts

Authorized Functions. SHOP Agent/Broker may create, collect, disclose, access, maintain, store, and use PII from CMS, Consumers, Applicants, Employers, Employees, Qualified Employers, Qualified Employees, and Enrollees, for: 1. Assisting with application, eligibility, and enrollment processes for QHPs offered through the FF-SHOPs or SBE-FP SHOPs; 2. Supporting FF-SHOP or SBE-FP SHOP QHP selection and enrollment by assisting with plan comparisons and plan selections; 3. Facilitating Employer premium contribution amount selections through the FF- SHOPs or SBE-FP SHOPs; 4. Facilitating payment of the initial and subsequent group premium amount for FF- SHOP or SBE-FP SHOP coverage; 5. Facilitating Employee and dependent enrollment and disenrollments in QHPs offered through the FF-SHOPs or SBE-FP SHOPs; 6. Handling FF-SHOP or SBE-FP SHOP coverage changes throughout the plan year that may impact eligibility, including but not limited to adding a new hire, removing an Employee no longer employed at a company, removing an Employee no longer employed full-time, and adding a newborn or spouse during a special enrollment period; 7. Assisting with filing appeals of FF-SHOP or SBE-FP SHOP eligibility determinations; 8. Providing Customer Service activities related to FF-SHOP or SBE-FP SHOP coverage if permitted under state and federal law, including correction of errors on FF-SHOP or SBE-FP SHOP applications and policies, handling complaints and appeals regarding FF-SHOP or SBE-FP SHOP coverage, responding to questions about FF-SHOP or SBE-FP SHOP insurance policies, assisting in communicating with FF-SHOP or SBE-FP SHOP issuers, assisting with communicating with state regulatory authorities regarding FF-SHOP or SBE-FP SHOP issues, and assistance in communicating with CMS, and FF-SHOP, or SBE-FP SHOP Workforces; 9. Conducting quality assurance activities, including assessment of consumer satisfaction related to SHOP Agent/Broker’s assistance with FF-SHOP or SBE-FP SHOP coverage; 10. Providing information, materials, and programs to educate Consumers, Applicants, Employers, Employees, Qualified Employers, Qualified Employees, and Enrollees about the use and maintenance of their FF-SHOP or SBE-FP SHOP health coverage and policies; 11. Carrying out SHOP Agent/Broker’s legal responsibilities related to QHP Issuer functions in the FFEs or SBE-FP SHOPs, as permitted or required by SHOP Agent/Broker’s contractual relationships with QHP Issuers; and 12. Other functions substantially similar to those enumerated above and such other functions that may be approved by CMS in writing from time to time.

Authorized Functions. SHOP Agent/Broker may create, collect, disclose, access, maintain, store, and use PII from CMS, Consumers, Applicants, Employers, Employees, Qualified Employers, Qualified Employees, and Enrollees, for: 1. Assisting with application, eligibility, and enrollment processes for QHPs offered through the FF-SHOPs or SBE-FP SHOPs; 2. Supporting FF-SHOP or SBE-FP SHOP QHP selection and enrollment by assisting with plan comparisons and plan selections; 3. Facilitating Employer premium contribution amount selections through the FF- FF-SHOPs or SBE-FP SHOPs; 4. Facilitating payment of the initial and subsequent group premium amount for FF- FF-SHOP or SBE-FP SHOP coverage; 5. Facilitating Employee and dependent enrollment and disenrollments in QHPs offered through the FF-SHOPs or SBE-FP SHOPs; 6. Handling FF-SHOP or SBE-FP SHOP coverage changes throughout the plan year that may impact eligibility, including but not limited to adding a new hire, removing an Employee no longer employed at a company, removing an Employee no longer employed full-time, and adding a newborn new born or spouse during a special enrollment period; 7. Assisting with filing appeals of FF-SHOP or SBE-FP SHOP eligibility determinations; 8. Providing Customer Service activities related to FF-SHOP or SBE-FP SHOP coverage if permitted under state and federal law, including correction of errors on FF-SHOP or SBE-FP SHOP applications and policies, handling complaints and appeals regarding FF-SHOP or SBE-FP SHOP coverage, responding to questions about FF-SHOP or SBE-FP SHOP insurance policies, assisting in communicating with FF-SHOP or SBE-FP SHOP issuers, assisting with communicating with state regulatory authorities regarding FF-SHOP or SBE-FP SHOP issues, and assistance in communicating with CMS, and FF-SHOP, SHOP or SBE-FP SHOP Workforces; 9. Conducting quality assurance activities, including assessment of consumer satisfaction related to SHOP Agent/BrokerXxxxxx’s assistance with FF-SHOP or SBE-FP SHOP coverage; 10. Providing information, materials, and programs to educate Consumers, Applicants, Employers, Employees, Qualified Employers, Qualified Employees, and Enrollees Enrollees, about the use and maintenance of their FF-SHOP or SBE-FP SHOP health coverage and policies; 11. Carrying out SHOP Agent/BrokerXxxxxx’s legal responsibilities related to QHP Issuer functions in the FFEs or SBE-FP SHOPs, as permitted or required by SHOP Agent/Broker’s contractual relationships with QHP Issuers; and 12. Other functions substantially similar to those enumerated above and such other functions that may be approved by CMS in writing from time to time.