Covered California for Small Business Participation Fees. (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 QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to Covered California. Covered California shall collect Participation Fee and Agent and General Agent compensation from premiums remitted by Employers and Employees.
(b) The Participation Fee payable to Covered California during each month of this Agreement shall be equal to five point two (5.2) percent of the gross premium attributable to each Enrollee in Contractor’s QDPs for such month plus additional fees as necessary to support distribution related expenses. The Participation Fee will be assessed by Covered California and payable monthly by Contractor based on premium attributable to enrollees in Contractor’s QDPs sold through the Covered California for Small Business for 2017-2022. The Participation Fee will be reviewed each year as part of the Covered California’s annual budget process. Should Covered California need to collect or refund any premiums for years 2014 to 2016, the Participation Fee shall be calculated pursuant to the QDP Issuer Agreement that was in place during the applicable plan year or years.
(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 forts at Sections 2.3.3 and 2.3.6. 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 the Covered California within thirty (30) days following receipt of su...
Covered California for Small Business Participation Fees. (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 QDPs and
Covered California for Small Business Participation Fees a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, the Exchange may generate funds through a participation fee (“Participation Fees”) on Contractor’s QHPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to the Exchange.
b) Contractor recognizes that the total cost of all Participation Fees for the Exchange must be collected by Contractor by spreading the cost across the premiums charged to Contractor’s entire small employer risk pool (both inside and outside the Exchange) for Covered California for Small Business Participation Fees. No rate charged to an Enrollee can have a higher per member per month fee to cover this overall Participation Fee than is charged to all other enrollees of the respective risk pool.
c) With respect to Covered California for Small Business, Contractor acknowledges that (i) the Exchange is responsible for collecting premiums from Employers and Employees, and (ii) the Exchange will remit applicable Employer and Employee premiums collected by the Exchange to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) agentAgent commissions determined in accordance with the terms set forth at Section 2.3.
Covered California for Small Business Participation Fees. (a) Contractor understands and agrees that (i) under the Affordable Care Act and the California Affordable Care Act, the Exchange may generate funds through a participation fee (“Participation Fees”) on Contractor’s QDPs and (ii) Contractor is responsible for the timely payment of any Participation Fees to the Exchange.
(b) The Participation Fee payable to the Exchange during each month of this Agreement shall be equal to a per member per month (“PMPM”) rate of $.83 multiplied by the number of Enrollees in Contractor’s QDPs for such month plus additional fees as necessary to pay agent commissions. This Participation fee is based on the Exchange’s estimates of the revenue required to support the transition of the Exchange to being self-sufficient beginning in 2015. The Participation Fee will be assessed by the Exchange and payable monthly by Contractor based on enrollment in Contractor's QDPs sold through the Covered California for Small Business Exchange.
(c) With respect to Covered California for Small Business, Contractor acknowledges that (i) the Exchange is responsible for collecting premiums from Employers and Employees, and (ii) the Exchange will remit applicable Employer and Employee premiums collected by the Exchange to Contractor, net of (1) Participation Fees computed in accordance with the Participation Methodology - Covered California for Small Business, and (2) agent commissions determined in accordance with the terms set forth at Section 2.3.
