Cost-Share Credit Clause Samples

Cost-Share Credit. If the State notifies Contractor of an Enrollee’s change in QHP, then Contractor must enroll the individual in the applicable QHP in accordance with the effective date of eligibility that is provided by the State and as detailed in the Trading Partner Agreement. Contractor must ensure that any cost sharing paid by the individual under the Contractors product is accounted for in the calculation of the deductibles and annual limitations on cost sharing in a new QHP within the same calendar year and shall resume accumulators. However, Contractor shall not be required to credit cost-sharing when a person moves from the individual market to the group market or when the individual moves from another contractor’s products back to Contractor products, Although, if an individual moves back into the individual market before the end of the calendar year, Contractor shall credit such cost-sharing previously earned in Contractor’s products. Contractor shall apply such credit at the subscriber level, meaning that if a dependent on a QHP moves to another QHP as a dependent of a different subscriber, the cost share earned by that dependent shall not credit to the new mid-year QHP. To the extent applicable the State and Contractor shall reconcile State Cost-Sharing Assistance consistent with the federal reconciliation process including reconciliation methodology, timing, data reporting requirements and any other federal requirements for reconciliation of the State Cost Sharing Assistance. The State and Contractor shall use best efforts to ensure reconciliation is efficient.