Covered California. Employer groups participating in the Covered California for Small Business (CCSB) program shall comply with the policies and standards established by Covered California, including but not limited to, the standards relating to Premium payment, eligibility and enrollment, and termination, whether or not specifically stated in this Agreement.
Covered California. The California Health Benefit Exchange, doing business as Covered California and an independent entity within the Government of the State.
Covered California. The California Health Benefit Exchange, doing business as Covered California and an independent entity within the Government of the State. – Covered California program which offers coverage to eligible small businesses and their employees, also referred to as the Small Business Health Options Program (SHOP) and described in Government Code § 100502(m).
Covered California. Agent shall maintain certification with Covered California. Agent acknowledges that WHA will not pay Agent Commission on premium received for Individuals enrolled through Covered California unless Agent maintains such certification. Agent acknowledges that Covered California is responsible for the payment of Commission for Groups enrolled through Covered California, and WHA will not pay Commission for such enrollments.
Covered California. WHA shall not pay Commission on premiums received for Groups enrolled through Covered California. WHA shall pay Commission on premiums collected for Individuals enrolled through Covered California pursuant to Section 2.9 of this Agreement.
Covered California. Employer Groups participating in the Covered California for Small Business (CCSB) program shall comply with the policies and standards established by Covered California including but not limited to the standards relating to Premium payment, eligibility and enrollment, and termination, whether or not specifically stated in this Agreement. This California Health Benefit Exchange Small Business Health Options (SHOP) Program Supplement Rider (the “Supplement”) supplements that certain Group Subscriber Agreement (the “Agreement”) between Sharp Health Plan (HEALTH PLAN) and GROUP. This Supplement is an integral part of the Agreement, and is intended by the Parties hereto to be interpreted to be consistent therewith; any inconsistencies or conflicts in terms with the Agreement are to be resolved in favor of the terms in this Supplement.
Covered California. The California Health Benefit Exchange, doing business as Covered California and an independent entity within the State of California. Delivery System Transformation - A set of initiatives taken by purchasers, employers, health plans or providers, together or individually, to drive the creation and preferred use of care delivery models that are designed to deliver higher value aligned with the “Triple Aim” goals of patient care experience including quality and satisfaction, improve the health of the populations, and reduce the per capita cost of health care services. Generally, these models require improved care coordination, provider and payer information sharing, and programs that identify and manage populations of individuals through care delivery and payment models. Dental Primary Care - Professional guidelines for addressing pediatric oral health needs are predicated on early and periodic clinical examinations to assess for evidence of pathologic changes or developmental abnormalities, diagnoses to determine treatment needs, and follow-up care for any conditions requiring treatment. These recurring periodic oral assessments ("dental checkups") are generally coupled with routine preventive services and increasingly seek to incorporate assessments of risk factors that elevate the likelihood of destructive changes if allowed to persist. This pattern of periodic assessments, preventive services, and necessary follow-up care also generally applies for adults, who collectively are more susceptible to the development of periodontal disease, oro-pharangeal cancers, and other soft tissue abnormalities. Dental Home - Oral health care is best delivered in a "dental home" where competent oral health care practitioners provide continuous and comprehensive services. It is recommended that a dental home be established at a young age. An adequate dental home shall be expected to provide patients with: an accurate examination and risk assessment for dental diseases; an individualized preventive dental health program based upon the examination and risk assessment; information about proper diet and nutrition practices; a continuing care provider that accomplishes restorative and surgical dental care when necessary in a manner consistent with the patient’s psychological needs; referrals to dental specialists when care cannot be directly provided within the dental home; and coordination of care with the patient’s primary care medical provider as applicable. Additionally, ...
Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by the Exchange and Contractor and shall establish a process to resolve any disagreements on premium amounts due in a timely manner and prior to transfer of funds to Contractor as required under this section.
Covered California. The Xxxxx Center for Urogynecology is NOT participating with these plans at this time.
Covered California. Final Health Plan Contract Attachments, May 2016, 2013 Attachment 16-5 6.04 (by 2015) 7.01 (when undertaken)
