Covered California for Small Business. Covered California for Small Business was established to assist Employers by facilitating enrollment of Employees into QDPs. Covered California will assume statutory obligation as required as part of initial enrollment that would otherwise be carried out by Contractor, such as assuring completion of Agent attestation, if applicable. All specified Employees, and their Family Members, of Employers who are eligible in accordance with the Affordable Care Act, California Affordable Care Act, and Regulations may obtain coverage through Covered California for Small Business as permitted by State and Federal laws, rules and regulations. Contractor shall process Covered California for Small Business enrollments from small businesses determined by Covered California to be eligible for coverage in the Covered California for Small Business in accordance with the terms set forth in this Agreement and State and Federal laws, rules and regulations.

Covered California for Small Business. The following provisions shall apply to the Covered California for Small Business: (i) In the event that Contractor continues to offer small group coverage in the State following the Notice of Non-Recertification Election, Contractor shall comply with applicable laws, rules and regulations relating to the discontinuation of a benefit package, including those set forth at Insurance Code § 10713. The termination of the Agreement shall occur upon the termination of coverage which shall be determined as follows: (1) Contractor shall provide coverage to Employers and Employees until the expiration of the Employer’s first Plan Year that commences after the Non- Recertification Election. (2) Contractor shall notify Employers and Employees that the Contractor’s QDP will not be available for renewal at least ninety (90) days prior to policy expiration. Non-renewal notification must be in a format approved by Covered California. (ii) Contractor shall comply with other requirements of Covered California relating to the continuation and transition of coverage following Contractor’s Non-Recertification Election, including without limitation, those relating to protocols and timing for the removal of Contractor from the listing of QDPs to be selected by Employers and Employees, the commencement of coverage for new Employers and Employees, and termination and transition of coverage.

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Covered California for Small Business. The Exchange program providing coverage to eligible small businesses, also referred to as the Small Business Health Options Program and described in Government Code 100502(m).

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Covered California for Small Business. The following provisions shall apply to the Covered California for Small Business: (i) In the event that Contractor continues to offer small group coverage in the State following the Notice of Non-Recertification Election, Contractor shall comply with applicable laws, rules and regulations relating to the discontinuation of a benefit package, including those set forth at Insurance Code § 10713. The termination of the Agreement shall occur upon the termination of coverage which shall be determined as follows: (1) If a plan elects not to recertify for the following year, it must continue to provide coverage until the expiration of coverage for Employers and Employees of the previous plan certification. Contractor shall continue to provide coverage to Employers and Employees until the expiration of the Employer’s Plan Year of Contractor’s last Certified Year. (2) Contractor shall notify Employers and Employees that the Contractor’s QDP will not be available for renewal at least ninety

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Covered California for Small Business. The following provisions shall apply to the Covered California for Small Business Exchange: (i) In the event that Contractor continues to offer small group coverage in the State following the Notice of Non-Recertification Election, Contractor shall comply with applicable laws, rules and regulations relating to the discontinuation of a benefit package, including those set forth at Section 10713 of the Insurance Code. The termination of the Agreement shall occur upon the termination of coverage which shall be determined as follows: (1) In the event that an Employer’s plan year, as determined in accordance with 45 C.F.R. § 155.725, expires between the July 1 effective date of the Non Recertification Election and the expiration of the Contract Year on December 31, Contractor shall provide coverage to Employers and Employees until the termination of the Agreement that shall be effective upon the expiration of the Employer’s first plan year that commences after the Non-Recertification Election. (2) In the event that an Employer’s plan year terminates between January 1 and the July 1 effective date of the Notice of Non-Recertification, Contractor shall provide coverage until the termination of the Agreement effective upon the expiration of Employer’s first plan year that commences prior to the July 1 effective date of the Notice of Non-Recertification. (3) In the event that an Employer’s plan year expires more than ninety (90) days following the Notice of Non-Recertification Election, the Exchange shall notify Employers and Employees in a format approved by the Exchange that Contractor’s QDP will not be available upon the next renewal anniversary date. (ii) Contractor shall comply with other requirements of the Exchange relating to the continuation and transition of coverage following Contractor’s Non-Recertification Election, including, without limitation, those relating to protocols and timing for the removal of Contractor from the listing of QDPs to be selected by Employers and Employees, the commencement of coverage for new Employers and Employees, and termination and transition of coverage.

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Covered California for Small Business. 5.1.1 Rates and Payments

Covered California for Small Business. Participation Fees and Agent Compensation a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, Covered California may generate funds through a participation fee (“Participation Fees”) on Contractor’s QHPs and (ii) Covered California shall collect Participation Fee and distribution related expenses from premiums remitted by Employers and Employees. b) Contractor recognizes that the total cost of all Participation Fees for Covered California must be spread across Contractor’s entire book of business in the single risk pool (both inside and outside Covered California) for the small employer market. c) With respect to Covered California for Small Business, Contractor acknowledges that (i) Covered California is responsible for collecting premiums from Employers and Employees, and (ii) Covered California will remit applicable Employer and Employee premiums collected by Covered California to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) Distribution related expenses determined in accordance with the terms set forth at Sections 2.2.3 and 2.2.6. Covered California for Small Business shall transfer funds to Contractor on a monthly basis or such other intervals as mutually agreed upon by Covered California 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. d) In the event that Contractor disputes the amount of Participation Fees billed or deducted by Covered California, Contractor shall submit a written notice of such dispute to Covered California within thirty (30) days following receipt of such bill or deduction by Covered California. Contractor’s notice will document the nature of the discrepancies, including reconciliation of any differences identified by Contractor in enrollment or premiums collected. Covered California will respond to Contractor within forty-five (45) days of receipt of the notice by either (i) paying the amount claimed by Contractor or (ii) providing a detailed explanation for the denial of the refund. If the Contractor still disputes the findings of Covered California, Contractor may pursue additional remedies in accordance with Section 12.1. e) Subject to the provisions of Section 10.5, Contractor agrees to a periodic audit or other examin...

Covered California for Small Business. 56.21.1 Rates and Payments (a) Schedule of Rates. The rates for the Covered California for Small Business Plan Year 2023 2024 and the annual update for Plan Years 2024 2025 and 20252026, are those rates submitted by Contractor during the Certification Process and subsequently uploaded and validated by Contractor through the SERFF Templates for each Plan Year. The parties acknowledge and agree that the premium rates for Covered California for Small Business are actuarially determined to assure that premium revenues and cost sharing contributions will provide the total dollar amount necessary to support (i) the provision of Covered Services by Contractor through its QDPs, (ii) administrative expenses and reasonable reserves by Contractor to meet the requirements outlined in this Agreement and in accordance with applicable laws, rules and regulations, and (iii) the Contractor’s payment by Contractor of the Participation Fee to Covered California. The Participation Fee payable with respect to Covered California Enrollees in Covered California for Small Business includes a fee specified by Covered California as necessary to support payment of distribution related expenses. Contractor acknowledges and agrees that any Participation Fees due to Covered California from Contractor shall be withheld by Covered California before passing through any premium payments received by Covered California from Employers and Employees to Contractor in accordance with paragraph (d) of this Section 56.21.1. (b) Updates. The Monthly Rates shall be established in accordance with the procedures set forth at Section 34.5. Covered California may authorize an update of rates no more frequently than on a quarterly basis in the Covered California for Small Business, in accordance with requirements and update schedules to be determined by Covered California.

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