Common use of Coverage Following Termination and Decertification Clause in Contracts

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. This cooperation shall include: (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or or iv. Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California the Exchange and the succeeding contractor as applicable, as reasonably requested by Covered Californiathe Exchange. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California the Exchange and the succeeding contractor as applicable, as reasonably requested by Covered Californiathe Exchange. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code Section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.

Coverage Following Termination and Decertification. (a) Upon the termination of the Agreement or and decertification of one or more of Contractor’s QHPs, Certified QHP Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another Certified QHP as directed by Covered Californiathe Exchange. This cooperation shall include: , without limitation, (i) attending post-post- termination meetings, (ii) providing or arranging for the provision of Covered Health Care Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and and/or (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the Exchange and/or the succeeding contractor contractor, each as applicable, as shall be reasonably requested by Covered Californiathe Exchange. (b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, QHP but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. (c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days calendar days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. (i) Until total disability ceases; (ii. ) For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; (iii. ) Until the Covered California Enrollee’s enrollment in a replacement plan; or or (iv. ) Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. This cooperation shall include: (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or or iv. Recertification.

Coverage Following Termination and Decertification. ‌ a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. This cooperation shall include: (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California the Exchange and the succeeding contractor as applicable, as reasonably requested by Covered Californiathe Exchange. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code Section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification. Without limiting the Exchange’s right to obtain indemnification or other forms of remedies or relief from Contractor or other third-parties, Contractor shall, at its sole cost and expense, obtain, and during the term of this Agreement, maintain in full force and effect, the insurance coverage described in this Section and as otherwise required by law, including, without limitation, coverage required to be provided and documented pursuant to Section 1351 (o) of the Health and Safety Code and relating to insurance coverage or self-insurance: (i) to respond to claims for damages arising out of the furnishing of Covered Services, (ii) to protect against losses of facilities where required by the director, and (iii) to protect against workers’ compensation claims arising out of work-related injuries that might be brought by the Employees and staff of Contractor. All insurance shall be adequate to provide coverage against losses and liabilities attributable to the acts or omissions of Contractor in performance of this Agreement and to otherwise protect and maintain the resources necessary to fulfill Contractor’s obligations under this Agreement. The minimum acceptable limits shall be as indicated below: i. Commercial general liability or equivalent self-insurance covering the risks of bodily injury (including death), property damage and personal injury, including coverage for contractual liability, with a limit of not less than $1 million per occurrence/$2 million general aggregate; ii. Comprehensive business automobile liability (owned, hired, or non-owned vehicles used by Contractor in connection with performance of its obligations under this Agreement) covering the risks of bodily injury (including death) and property damage, including coverage for contractual liability, with a limit of not less than $1 million per accident; iii. Employers liability insurance covering the risks of Contractor’s Employees and Employees’ bodily injury by accident or disease with limits of not less than $1 million per accident for bodily injury by accident and $1 million per employee for bodily injury by disease and $1 million disease policy limit; iv. Umbrella policy providing excess limits over the primary general liability, automobile liability and employer’s liability policies in an amount not less than $10 million per occurrence and in the aggregate; v. Crime coverage at such levels consistent with industry standards and reasonably determined by Contractor to cover occurrences falling in the following categories: computer and funds transfer fraud; forgery; money and securities; and employee theft; and vi. Professional liability or errors and omissions with coverage of not less than $1 million per claim/$2 million general aggregate.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California the Exchange and the succeeding contractor as applicable, as reasonably requested by Covered Californiathe Exchange. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification. a) Without limiting the Exchange’s right to obtain indemnification or other forms of remedies or relief from Contractor or other third-parties, Contractor shall, at its sole cost and expense, obtain, and during the term of this Agreement, maintain in full force and effect, the insurance coverage described in this Section and as otherwise required by law, including, without limitation, coverage required to be provided and documented pursuant to Section 1351 (o) of the Health and Safety Code and relating to insurance coverage or self-insurance: (i) to respond to claims for damages arising out of the furnishing of Covered Services, (ii) to protect against losses of facilities where required by the director, and (iii) to protect against workers’ compensation claims arising out of work-related injuries that might be brought by the employees and staff of Contractor. All insurance shall be adequate to provide coverage against losses and liabilities attributable to the acts or omissions of Contractor in performance of this Agreement and to otherwise protect and maintain the resources necessary to fulfill Contractor’s obligations under this Agreement. The minimum acceptable limits shall be as indicated below: i. Commercial general liability or equivalent self-insurance covering the risks of bodily injury (including death), property damage and personal injury, including coverage for contractual liability, with a limit of not less than $1 million per occurrence/$2 million general aggregate; ii. Comprehensive business automobile liability (owned, hired, or non-owned vehicles used by Contractor in connection with performance of its obligations under this Agreement) covering the risks of bodily injury (including death) and property damage, including coverage for contractual liability, with a limit of not less than $1 million per accident; iii. Employers liability insurance covering the risks of Contractor’s employees and employees’ bodily injury by accident or disease with limits of not less than $1 million per accident for bodily injury by accident and $1 million per employee for bodily injury by disease and $1 million disease policy limit; iv. Umbrella policy providing excess limits over the primary general liability, automobile liability and employer’s liability policies in an amount not less than $10 million per occurrence and in the aggregate; v. Crime coverage at such levels consistent with industry standards and reasonably determined by Contractor to cover occurrences falling in the following categories: computer and funds transfer fraud; forgery; money and securities; and employee theft; and vi. Professional liability or errors and omissions with coverage of not less than $1 million per claim/$2 million general aggregate.

Coverage Following Termination and Decertification. (a) Upon the termination of the Agreement or and decertification of one or more of Contractor’s QHPs, Certified QHP Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another Certified QHP as directed by Covered Californiathe Exchange. This cooperation shall include: , without limitation, (i) attending post-post- termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and and/or (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the Exchange and/or the succeeding contractor contractor, each as applicable, as shall be reasonably requested by Covered Californiathe Exchange. (b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, QHP but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. (c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days calendar days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. (i) Until total disability ceases; (ii. ) For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; (iii. ) Until the Covered California Enrollee’s enrollment in a replacement plan; or or (iv. ) Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or xxxxx decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: , without limitation: (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and and/or (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the Exchange and/or the succeeding contractor as applicable, each as shall be reasonably requested by Covered Californiathe Exchange. b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or or iv. Recertification.

Coverage Following Termination and Decertification. (a) Upon the termination of the Agreement or and decertification of one or more of Contractor’s QHPs, Certified QHP Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another Certified QHP as directed by Covered Californiathe Exchange. This cooperation shall include: , withou t limitation, (i) attending post-post- termination meetings, (ii) providing or arranging for the provision of Covered Health Care ServicesCovered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and and/or (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the Exchange and/or the succeeding contractor contractor, each as applicable, as shall be reasonably requested by Covered Californiathe Exchange. (b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, QHP but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP.. Covered California – Final Health Plan Contract – May 202117, 2013 36 (c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days calendar days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. (i) Until total disability ceases; (ii. ) For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; (iii. ) Until the Covered California Enrollee’s enrollment in a replacement plan; or or (iv. ) Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered California. . This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the succeeding contractor as applicable, as reasonably requested by Covered California. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. . For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. . Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. . Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day day intervals during the period that the extension of benefits is in effect. . The extension of benefits shall be solely in connection with the condition causing total disability. . This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or or iv. Recertification.

Coverage Following Termination and Decertification. (a) Upon the termination of the Agreement or and decertification of one or more of Contractor’s QHPs, Certified QHP Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another Certified QHP as directed by Covered Californiathe Exchange. This cooperation shall include: , without limitation, (i) attending post-such post- termination meetings, (ii) providing or arranging for the provision of Covered Health Care Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and and/or (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the Exchange and/or the succeeding contractor contractor, each as applicable, as shall be reasonably requested by Covered Californiathe Exchange. (b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, QHP but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. (c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days calendar days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. (i) Until total disability ceases;; Covered California – Draft Health Plan Contract -- April 22, 2013April 298, 2013 (ii. ) For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; (iii. ) Until the Covered California Enrollee’s enrollment in a replacement plan; or or (iv. ) Recertification.

Coverage Following Termination and Decertification. a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California the Exchange and the succeeding contractor as applicable, as reasonably requested by Covered Californiathe Exchange. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.. ARTICLE 8 –INSURANCE AND INDEMNIFICATION a) Without limiting the Exchange’s right to obtain indemnification or other form of remedies or relief from Contractor or other third-parties, Contractor shall, at its sole cost and expense, obtain, and, during the term of this Agreement, maintain, in full force and effect, the insurance coverage described in this Section and/or as otherwise required by law, including, without limitation, coverage required to be provided and documented pursuant to Section 1351 (o) of the Health and Safety Code and relating to insurance coverage or self-insurance: (i) to respond to claims for damages arising out of the furnishing of Covered Services, (ii) to protect against losses of facilities where required by the director, and (iii) to protect against workers’ compensation claims arising out of work-related injuries that might be brought by the Employees and staff of Contractor. All insurance shall be adequate to provide coverage against losses and liabilities attributable to the acts or omissions of Contractor in performance of this Agreement and to otherwise protect and maintain the resources necessary to fulfill Contractor’s obligations under this Agreement. The minimum acceptable limits shall be as indicated below: i. Commercial general liability or equivalent self-insurance covering the risks of bodily injury (including death), property damage and personal injury, including coverage for contractual liability, with a limit of not less than $1 million per occurrence/$2 million general aggregate; ii. Comprehensive business automobile liability (owned, hired, or non-owned vehicles used by Contractor in connection with performance of its obligations under this Agreement) covering the risks of bodily injury (including death) and property damage, including coverage for contractual liability, with a limit of not less than $1 million per accident;

Coverage Following Termination and Decertification. ‌ a) Upon the termination of the Agreement or decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: : (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and (iii) communicating with affected Covered California Enrollees in cooperation with Covered California the Exchange and the succeeding contractor as applicable, as reasonably requested by Covered Californiathe Exchange. b) In the event the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disability. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or iv. Recertification.

Coverage Following Termination and Decertification. ‌ a) Upon the termination of the Agreement or xxxxx decertification of one or more of Contractor’s QHPs, Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another QHP as directed by Covered Californiathe Exchange. This cooperation shall include: , without limitation: (i) attending post-termination meetings, (ii) providing or arranging for the provision of Covered Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and and/or (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the Exchange and/or the succeeding contractor as applicable, each as shall be reasonably requested by Covered Californiathe Exchange. b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. Until total disability ceases; ii. For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; iii. Until the Covered California Enrollee’s enrollment in a replacement plan; or or iv. Recertification.

Coverage Following Termination and Decertification. (a) Upon the termination of the Agreement or and decertification of one or more of Contractor’s QHPs, Certified QHP Contractor shall cooperate fully with Covered California the Exchange in order to effect an orderly transition of Covered California Enrollees to another Certified QHP as directed by Covered Californiathe Exchange. This cooperation shall include: , without limitation, (i) attending post-such post- termination meetings, (ii) providing or arranging for the provision of Covered Health Care Services as may be deemed necessary by Participating Providers to assure the appropriate continuity of care, and and/or (iii) communicating with affected Covered California Enrollees in cooperation with Covered California and the Exchange and/or the succeeding contractor contractor, each as applicable, as shall be reasonably requested by Covered Californiathe Exchange. (b) In the event of the termination or expiration of the Agreement requires the transfer of some or all Covered California Enrollees into any other health plan, the terms of coverage under Contractor’s QHP shall not be carried over to the replacement QHP, QHP but rather the transferred Covered California Enrollees shall be entitled only to the extent of coverage offered through the replacement QHP as of the effective date of transfer to the new QHP. (c) Notwithstanding the foregoing, the coverage of a Covered California Enrollee under Contractor’s QHP may be extended to the extent that a Covered California an Enrollee qualifies for an extension of benefits including, those to effect the continuity of care required due to hospitalization or disabilitydisability pursuant to Health and Safety Code section 1399.62. For purposes of this Agreement, “disability” means that the Covered California Enrollee has been certified as being totally disabled by the Covered California Enrollee’s treating physician, and the certification is approved by Contractor. Such certification must be submitted for approval within thirty (30) Days calendar days from the date coverage is terminated. Recertification of Covered California Enrollee’s disability status must be furnished by the treating Provider not less frequently than at sixty (60) Day calendar day intervals during the period that the extension of benefits is in effect. The extension of benefits shall be solely in connection with the condition causing total disability. This extension, which is contingent upon payment of the applicable premiums, shall be provided for the shortest of the following periods: i. (i) Until total disability ceases; (ii. ) For a maximum period of twelve (12) months after the date of termination, subject to plan maximums; (iii. ) Until the Covered California Enrollee’s enrollment in a replacement plan; or or (iv. ) Recertification.